Overview
Rheumatoid arthritis (RA) is a chronic inflammatory disease characterized by joint pain, swelling, and stiffness. Remission is defined as minimal disease activity or absence of clinical signs of inflammation.Diagnosis
Management
Janus kinase (JAK) inhibitors (jakinibs) are a treatment option for patients with severe RA who have not achieved remission or low disease activity, or who experience side effects with conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) and biologic DMARDs (bDMARDs) 1.
Jakinibs can be used as monotherapy or in combination with methotrexate 1.
Specific jakinibs evaluated include tofacitinib, peficitinib, decernotinib, upadacitinib, baricitinib, and filgotinib 1.
Upadacitinib demonstrated better results compared to other jakinibs for ACR 20, 50, 70, and CRP-DAS28 for low disease activity (LDA) and remission 1.
Tofacitinib achieved the best result for ESR-DAS28 for remission 1.Special Populations
Jakinibs should be avoided in patients with severe liver and kidney disease 1.Key Recommendations
Jakinibs can be considered for patients with severe RA who have failed csDMARDs and/or bDMARDs, either as monotherapy or in combination with methotrexate 1. (Evidence: Moderate)
When considering jakinibs, upadacitinib showed superior efficacy compared to other agents for ACR 20, 50, 70, and CRP-DAS28 for LDA and remission 1. (Evidence: Moderate)
Tofacitinib demonstrated the best efficacy for ESR-DAS28 remission among the evaluated jakinibs 1. (Evidence: Moderate)
Caution is advised regarding the use of jakinibs in patients with severe liver and kidney disease 1. (Evidence: Expert opinion)References
1 Rocha CM, Alves AM, Bettanin BF, Majolo F, Gehringer M, Laufer S et al.. Current jakinibs for the treatment of rheumatoid arthritis: a systematic review. Inflammopharmacology 2021. link