Clinician reference tool — not medical advice. This is a clinical decision-aid intended for healthcare professionals: it gives deterministic suggestions to think with, not a diagnosis or a prescription. If you’re a patient, you’re welcome to look around — but please review anything here with your own doctor; it isn’t a substitute for personalized medical care.
Reference tool — not medical advice. Deterministic treat-to-target suggestions to think with, grounded in current rheumatology guidelines. The model drafts options; a clinician decides. Runs entirely in your browser — no data is collected.

Evidence: Smolen JS 2025 · sources last checked 2026-07-22

Rheumatoid arthritis treatment selector

Pick the treatment line, disease activity, prognosis, and any cautions to get ranked treat-to-target DMARD suggestions — across the Health Canada-approved conventional synthetic, biologic, and targeted synthetic disease-modifying agents — with the guideline reasoning and references behind each.

Guideline lens

Patient profile

Treatment line

Disease activity

Prognosis

Cautions & contraindications

Pregnancy makes methotrexate + leflunomide (and triple therapy) ineligible.

Select a patient profile to begin.

e.g. DMARD-naïve + low disease activity, or MTX inadequate response + poor prognostic factors to see how the ranking shifts.

References

  1. [1]Fraenkel L, et al. 2021 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis. Arthritis Care Res 2021;73(7):924. link
  2. [2]Smolen JS, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological DMARDs: 2022 update (with 2025 update). Ann Rheum Dis. link
  3. [3]Canadian Rheumatology Association (CRA) recommendations for the pharmacological management of rheumatoid arthritis. J Rheumatol / rheum.ca. link
  4. [6]Health Canada — Drug Product Database & product monographs (methotrexate/Metoject, Plaquenil, Salazopyrin, Arava, Humira, Enbrel, Remicade, Simponi, Cimzia, Orencia, Actemra, Kevzara, Rituxan, Xeljanz, Olumiant, Rinvoq). link
  5. [7]O'Dell JR, et al. Therapies for active rheumatoid arthritis after methotrexate failure (triple therapy vs etanercept). NEJM 2013;369:307. link
  6. [8]Ytterberg SR, et al. ORAL Surveillance: Cardiovascular and cancer risk with tofacitinib in rheumatoid arthritis. NEJM 2022;386:316. link
  7. [9]Health Canada / product monographs — TB & hepatitis B/C screening and infection warnings for TNF inhibitors, non-TNF biologics, and JAK inhibitors; rituximab hepatitis-B reactivation warning. link