VIDEO: How to treat patients with RA who do not respond to conventional therapies

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You know, we certainly have guidelines, and those are really open to a lot of interpretation and the use of shared decision-making, which is something I'm very passionate about. So, certainly if someone fails methotrexate, for instance, and optimizing that, going to subcutaneous administration, and still don't respond to that, certainly, I think there is the option for triple therapy in terms of adding hydroxychloroquine, sulfasalazine vs. adding a biologic or a TNF inhibitor. And that's kind of the first fork in the road. And that's really eliciting, you know, what does the patient prefer? Do they prefer to take only oral therapy? Do they want sort of the fastest, best thing? It doesn't matter if it's injectable, infusion, et cetera. So, I think going through the options, letting the patient know there are options, and describing clearly the benefits and the potential harms of each of those. And then also what is the burden of treatment for the patient in terms of getting lab monitoring? And again, as I mentioned, the administration of the therapy and their sense of their own willingness to take a risk in terms of potential harm, and that varies from person to person and also over the time course of someone's life with rheumatoid arthritis. So, it's really individualized tailoring for the patient who's in front of me, as well as the evidence that we have supporting the different therapies.