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The American College of Rheumatology has issued updated recommendations for the use of both nonbiologic and biologic disease-modifying drugs to treat rheumatoid arthritis.

The statement, released online in Arthritis & Rheumatism, called them "recommendations, rather than guidelines" and emphasized they are not meant "to be used in a 'cookbook' or prescriptive manner."

The college recommends leflunomide or methotrexate as monotherapy for patients with disease of any duration or degree of activity; hydroxychloroquine or minocycline for those without poor prognostic features, low disease activity, and disease of short duration; and sulfasalazine for patients with all disease durations or degrees of disease activity but without poor prognostic features.

The college also issued recommendations for double and triple drug combinations and for anti–tumor necrosis factor agents in various stages of disease.

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