Highlights

• Leflunomide or methotrexate monotherapy is recommended for patients with all disease durations and for all degrees of disease activity, regardless of poor prognostic features (such as active disease with high tender and swollen joint counts; radiographic erosions; elevated rheumatoid factor or anti-CCP antibodies, SED rate or levels of C-reactive protein; early disability; age; and female gender.)
• Sulfasalazine monotherapy is recommended for all patients with all disease durations and degrees of disease activity, but without poor prognostic features.
• Hydroxychloroquine and minocycline are recommended for patients without poor prognostic features, with low disease activity and disease duration <24 months. 
• The dual combination of methotrexate plus hydroxychloroquine is recommended for patients with moderate to high disease activity regardless of disease duration or poor prognostic features.  It is also recommended for patients with long disease duration and low disease activity.
• Methotrexate plus sulfasalazine is recommended for patients of all disease durations and high disease activity and poor prognostic features. 
• The triple combination of methotrexate, hydroxychloroquine and sulfasalazine is recommended for patients with poor prognostic features and high disease activity, regardless of disease duration.
• The ACR recommends anti-TNF agents in combination with methotrexate in early RA (<3 months) only for patients with high disease activity and who haven't taken DMARDs before. 
• For patients with intermediate or long disease duration, anti-TNF agents are recommended for patients who have not responded to methotrexate treatment.
• Abatacept and Rituximab are recommended only for patients who had moderate to high disease activity, poor prognostic features and an inadequate response to methotrexate in combination with other DMARDs or failed to respond to sequential treatment with other DMARDs.
• Combinations of biologic agents are not recommended because of the higher incidence of adverse events and/or lack of added efficacy.
• Active bacterial infection, active herpes zoster viral infection, active or latent tuberculosis or acute or chronic hepatitis B and C are all contraindication to initiation or resumption of DMARD use.
• Influenza and pneumococcal vaccines are generally recommended, as well as hepatitis B vaccine if patient is at risk.
• Heart failure, lymphoma, multiple sclerosis or demyelinating disorders are contraindications for the use of anti-TNF agents.
• Women who are planning for pregnancy, pregnant or breastfeeding should not use methotrexate, minocycline or leflunomide. 

For more information on the new guidelines, see this article from the American College of Rheumatology.