Week | MTX* | PRED | HCQ | Anti-TNF |
|---|
mg/week | 10 mg/day | 400 mg/day | |
|---|
0 = start of study | 10 | + | – | – |
+ 4 | 15 | + | – | – |
+ 4 | 20 | + | – | – |
+ 4 | 25 | + | + | – |
+ 4 | 30 | + | + | – |
+ 4 | Same dose s.c. | + | + | – |
+ 4 | Same dose s.c. | + | – | + |
+ 4 | Same dose s.c. | + | – | + |
+ 4 | Same dose s.c. | + | – | + |
- If remission is not achieved after each period of 4 weeks, treatment is intensified stepwise. MTX methotrexate, PRED prednisolone, HCQ hydroxychloroquine, anti-TNF anti-tumor necrosis factor, s.c. subcutaneously
- *Same dose s.c.: the dose at the previous step, given s.c. at a dose of 30 mg, or earlier. In case of dose-dependent adverse reactions to MTX (> 10 mg/week), previously tolerated dose will be administered s.c., and this will then be the maximum tolerable dose (MTD) for that patient. Further intensifying treatment would be adding or continuing HCQ. HCQ is given for three consecutive months in every scenario
