Portuguese guidelines for the use of biological agents in rheumatoid arthritis - March 2010 update.
The authors present the revised version of the Portuguese Society of Rheumatology (SPR) guidelines for the treatment of rheumatoid arthritis (RA) with biological therapies. In these guidelines the criteria for introduction and maintenance of biological agents are discussed as well as the contraindications and procedures in the case of non-responders. Biological treatment should be considered in RA patients with a disease activity score 28 (DAS 28) superior to 3.2 despite treatment with 20mg/week of methotrexate (MTX) for at least 3 months or, if such treatment is not possible, after 6 months of other conventional disease modifying drug or combination therapy. A DAS 28 score between 2.6 and 3.2 with a significant functional or radiological deterioration under treatment with conventional regimens could also constitute an indication for biological treatment. The treatment goal should be remission or, if that is not achievable, at least a low disease activity, characterized by a DAS28 lower than 3.2, without significative functional or radiological worsening. The response criteria, at the end of the first 3 months of treatment, are a decrease of 0.6 in the DAS28 score. After 6 months of treatment response criteria is defined as a decrease of more than 1.2 in the DAS28 score. Non-responders, in accordance to the Rheumatologist's clinical opinion, should try a switch to another biological agent (tumour necrosis factor antagonist, abatacept, rituximab or tocilizumab).
Fonseca
João Eurico
JE
Canhão
Helena
H
Reis
Paulo
P
Santos
Maria José
MJ
Branco
Jaime
J
Quintal
Alberto
A
Malcata
Armando
A
Araújo
Domingos
D
Ventura
Francisco
F
Figueiredo
Guilherme
G
da Silva
José Canas
JC
Patto
José Vaz
JV
de Queiroz
Mário Viana
MV
Santos
Rui André
RA
Neto
Adriano José
AJ
de Matos
Alves de
Ad
Rodrigues
Ana
A
Mourão
Ana Filipa
AF
Ribeiro
Ana Sofia
AS
Cravo
Ana Rita
AR
Barcelos
Anabela
A
Cardoso
Anabela
A
Vilar
António
A
Braña
Arecili
A
Faustino
Augusto
A
Silva
Candida
C
Godinho
Fátima
F
Cunha
Inês
I
Costa
José António
JA
Gomes
José António Melo
JA
Pinto
José António Araújo
JA
da Silva
J A Pereira
JA
Miranda
Luís Cunha
LC
Inês
Luís
L
Santos
Luís Maurício
LM
Cruz
Margarida
M
Salvador
Maria João
MJ
Ferreira
Maria Júlia
MJ
Rial
Maria
M
Bernardes
Miguel
M
Bogas
Mónica
M
Araújo
Paula
P
Machado
Pedro
P
Pinto
Patrícia
P
de Melo
Rui Gomes
RG
Cortes
Sara
S
Alcino
Sérgio
S
Capela
Susana
S
D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D001691:Biological Therapy; D006801:Humans