title: Use of biological therapies in rheumatoid arthritis management: a comparison between the main worldwide and brazilian recommendations.
abstract: BACKGROUND
  Rheumatoid arthritis (RA) is a chronic systemic and progressive inflammatory disorder of the joints, which can result in deformity and functional disability. The diagnosis, treatment, and follow-up of patients with RA vary worldwide. The major societies of rheumatology, as well as governmental agencies in most countries, have tried to establish recommendations addressing diagnosis, treatment, and follow-up of RA. Despite the rapid advance in discovering new drugs, with increasingly efficient therapeutic responses, these recommendations have not been updated accordingly. Thus, efforts should be focused on standardizing the procedures established.
  
  
  OBJECTIVE
  Compare the main international recommendations for treatment of RA with the Brazilian protocols of the Brazilian Society of Rheumatology and Ministry of Health.
  
  
  METHODS
  The protocols of the following entities for treating RA were assessed: Brazilian Ministry of Health, Brazilian Society of Rheumatology, PANLAR/GLADAR, American College of Rheumatology, European League Against Rheumatism (EULAR), and Mexican College of Rheumatology.
  
  
  RESULTS
  Significant differences were identified between the several recommendations, especially regarding the criteria for beginning biological therapies, hierarchic sequence for using available biological drugs, and for suspending or switching them.
  
  
  CONCLUSIONS
  The recommendations for treatment of RA should be more frequently updated. The worldwide standardization of criteria for elaborating recommendations would be of great value to provide similar guidance to rheumatologists in countries and regions throughout the world.
authors.affiliation: Rheumatology Service of the Hospital Geral Universitario, Universidade de Cuiaba, Brazil. vf@uol.com.br
authors.forename: Vander
authors.initials: V
authors.lastname: Fernandes
authors.forename: Tassia Moraes
authors.initials: TM
authors.lastname: de Assis
authors.forename: Carolina Carla
authors.initials: CC
authors.lastname: Queiroz
authors.forename: Patrícia Pires Rey
authors.initials: PP
authors.lastname: de Figueiredo
authors.forename: Rafaela Untar
authors.initials: RU
authors.lastname: de Oliveira
authors.forename: Nilzio Antonio
authors.initials: NA
authors.lastname: da Silva
mesh_terms: D001172:Arthritis, Rheumatoid / Q000628:therapy*; D001691:Biological Therapy; D001938:Brazil; D006801:Humans; D038622:Internationality; D017410:Practice Guidelines as Topic