title: Portuguese guidelines for the use of biological agents in rheumatoid arthritis - October 2011 update.
abstract: 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 nonresponders. Biological treatment (with a tumour necrosis factor antagonist, abatacept or tocilizumab) should be considered in RA patients with a disease activity score 28 (DAS 28) equal to or greater than 3.2 despite treatment with at least 20mg-weekly-dose of methotrexate (MTX) for at least 3 months or, if such treatment is not possible, after 3 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, defined 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 at least 0.6 in the DAS28 score. After 6 months of treatment res­ponse criteria is defined as a decrease greater 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).
authors.affiliation: Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, Portugal. jefonseca@netcabo.pt
authors.forename: João Eurico
authors.initials: JE
authors.lastname: Fonseca
authors.forename: Miguel
authors.initials: M
authors.lastname: Bernardes
authors.forename: Helena
authors.initials: H
authors.lastname: Canhão
authors.forename: Maria José
authors.initials: MJ
authors.lastname: Santos
authors.forename: Alberto
authors.initials: A
authors.lastname: Quintal
authors.forename: Armando
authors.initials: A
authors.lastname: Malcata
authors.forename: Adriano
authors.initials: A
authors.lastname: Neto
authors.forename: Ana
authors.initials: A
authors.lastname: Cordeiro
authors.forename: Ana
authors.initials: A
authors.lastname: Rodrigues
authors.forename: Ana Filipa
authors.initials: AF
authors.lastname: Mourão
authors.forename: Ana Sofia
authors.initials: AS
authors.lastname: Ribeiro
authors.forename: Ana Rita
authors.initials: AR
authors.lastname: Cravo
authors.forename: Anabela
authors.initials: A
authors.lastname: Barcelos
authors.forename: Anabela
authors.initials: A
authors.lastname: Cardoso
authors.forename: António
authors.initials: A
authors.lastname: Vilar
authors.forename: Arecili
authors.initials: A
authors.lastname: Braña
authors.forename: Augusto
authors.initials: A
authors.lastname: Faustino
authors.forename: Candida
authors.initials: C
authors.lastname: Silva
authors.forename: Cátia
authors.initials: C
authors.lastname: Duarte
authors.forename: Domingos
authors.initials: D
authors.lastname: Araújo
authors.forename: Dolores
authors.initials: D
authors.lastname: Nour
authors.forename: Elsa
authors.initials: E
authors.lastname: Sousa
authors.forename: Eugénia
authors.initials: E
authors.lastname: Simões
authors.forename: Fátima
authors.initials: F
authors.lastname: Godinho
authors.forename: Filipe
authors.initials: F
authors.lastname: Brandão
authors.forename: Francisco
authors.initials: F
authors.lastname: Ventura
authors.forename: Graça
authors.initials: G
authors.lastname: Sequeira
authors.forename: Guilherme
authors.initials: G
authors.lastname: Figueiredo
authors.forename: Inês
authors.initials: I
authors.lastname: Cunha
authors.forename: J Alves
authors.initials: JA
authors.lastname: Matos
authors.forename: Jaime
authors.initials: J
authors.lastname: Branco
authors.forename: João
authors.initials: J
authors.lastname: Ramos
authors.forename: José António
authors.initials: JA
authors.lastname: Costa
authors.forename: José António
authors.initials: JA
authors.lastname: Gomes
authors.forename: José
authors.initials: J
authors.lastname: Pinto
authors.forename: José Canas
authors.initials: JC
authors.lastname: Silva
authors.forename: J A
authors.initials: JA
authors.lastname: Silva
authors.forename: José Vaz
authors.initials: JV
authors.lastname: Patto
authors.forename: Lúcia
authors.initials: L
authors.lastname: Costa
authors.forename: Luís Cunha
authors.initials: LC
authors.lastname: Miranda
authors.forename: Luís
authors.initials: L
authors.lastname: Inês
authors.forename: Luís Maurício
authors.initials: LM
authors.lastname: Santos
authors.forename: Margarida
authors.initials: M
authors.lastname: Cruz
authors.forename: Maria João
authors.initials: MJ
authors.lastname: Salvador
authors.forename: Maria Júlia
authors.initials: MJ
authors.lastname: Ferreira
authors.forename: Maria
authors.initials: M
authors.lastname: Rial
authors.forename: Mário Viana
authors.initials: MV
authors.lastname: Queiroz
authors.forename: Mónica
authors.initials: M
authors.lastname: Bogas
authors.forename: Paula
authors.initials: P
authors.lastname: Araújo
authors.forename: Paulo
authors.initials: P
authors.lastname: Reis
authors.forename: Pedro
authors.initials: P
authors.lastname: Abreu
authors.forename: Pedro
authors.initials: P
authors.lastname: Machado
authors.forename: Patrícia
authors.initials: P
authors.lastname: Pinto
authors.forename: Rui
authors.initials: R
authors.lastname: André
authors.forename: Rui
authors.initials: R
authors.lastname: Melo
authors.forename: Sandra
authors.initials: S
authors.lastname: Garcês
authors.forename: Sara
authors.initials: S
authors.lastname: Cortes
authors.forename: Sérgio
authors.initials: S
authors.lastname: Alcino
authors.forename: Sofia
authors.initials: S
authors.lastname: Ramiro
authors.forename: Susana
authors.initials: S
authors.lastname: Capela
mesh_terms: D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D001688:Biological Products / Q000627:therapeutic use*; D006801:Humans; D011174:Portugal
chemical_list: D001688:Biological Products