A proposed treatment algorithm for rheumatoid arthritis: aggressive therapy, methotrexate, and quantitative measures.

1. Tre atment should be aggre s s ive, directed towards remission or a near remission status for pat i e n t s , w i t h changes every 2-6 months (usually within 2 to 4 months) if results are not meeting this goal. 2. Early use of methotrexate is recommended, as most patients will ultim at e ly take methotrex ate and its l o n g t e rm re c o rd of effe c t ive n e s s and safety would make it the treatment of choice for most patients. 3. R h e u m at o l ogists should include a q u a n t i t at ive measure to document clinical stat u s , wh i ch could be a joint count, formal disease activity s c o re (DAS) (1) or the simplifi e d disease activity index (SDAI) (2), health assessment questionnaire ( H AQ) (3) or a mu l t i d i m e n s i o n a l version (MDHAQ) (4), visual analog scale scores for pain and patient and physician global assessments, the erythrocyte sedimentation rate or C-reactive protein.