title: 2012 Brazilian Society of Rheumatology Consensus for the treatment of rheumatoid arthritis.
abstract: OBJECTIVE
  To elaborate recommendations for the treatment of rheumatoid arthritis in Brazil.
  
  
  METHODS
  Literature review with articles' selection based on evidence and the expert opinion of the Rheumatoid Arthritis Committee of the Brazilian Society of Rheumatology.
  
  
  CONCLUSIONS
  1) The therapeutic decision should be shared with the patient; 2) immediately after the diagnosis, a disease-modifying antirheumatic drug (DMARD) should be prescribed, and the treatment adjusted to achieve remission; 3) treatment should be conducted by a rheumatologist; 4) the initial treatment includes synthetic DMARDs; 5) methotrexate is the drug of choice; 6) patients who fail to respond after two schedules of synthetic DMARDs should be assessed for the use of biologic DMARDs; 7) exceptionally, biologic DMARDs can be considered earlier; 8) anti-TNF agents are preferentially recommended as the initial biologic therapy; 9) after therapeutic failure of a first biologic DMARD, other biologics can be used; 10) cyclophosphamide and azathioprine can be used in severe extra-articular manifestations; 11) oral corticoid is recommended at low doses and for short periods of time; 12) non-steroidal anti-inflammatory drugs should always be prescribed in association with a DMARD; 13) clinical assessments should be performed on a monthly basis at the beginning of treatment; 14) physical therapy, rehabilitation, and occupational therapy are indicated; 15) surgical treatment is recommended to correct sequelae; 16) alternative therapy does not replace traditional therapy; 17) family planning is recommended; 18) the active search and management of comorbidities are recommended; 19) the patient's vaccination status should be recorded and updated; 20) endemic-epidemic transmissible diseases should be investigated and treated.
authors.affiliation: Programa de Pós-graduação em Ciências Médicas, Faculdade de Medicina, Universidade de Brasília.
authors.forename: Licia Maria Henrique
authors.initials: LM
authors.lastname: da Mota
authors.forename: Boris Afonso
authors.initials: BA
authors.lastname: Cruz
authors.forename: Claiton Viegas
authors.initials: CV
authors.lastname: Brenol
authors.forename: Ivanio Alves
authors.initials: IA
authors.lastname: Pereira
authors.forename: Lucila Stange
authors.initials: LS
authors.lastname: Rezende-Fronza
authors.forename: Manoel Barros
authors.initials: MB
authors.lastname: Bertolo
authors.forename: Max Victor Carioca
authors.initials: MV
authors.lastname: de Freitas
authors.forename: Nilzio Antonio
authors.initials: NA
authors.lastname: da Silva
authors.forename: Paulo
authors.initials: P
authors.lastname: Louzada-Júnior
authors.forename: Rina Dalva Neubarth
authors.initials: RD
authors.lastname: Giorgi
authors.forename: Rodrigo Aires Corrêa
authors.initials: RA
authors.lastname: Lima
authors.forename: Geraldo
authors.initials: G
authors.lastname: da Rocha Castelar Pinheiro
mesh_terms: D001172:Arthritis, Rheumatoid / Q000188:drug therapy / Q000628:therapy*; D001938:Brazil; D003663:Decision Trees; D006801:Humans