title: 2014 update of the Consensus Statement of the Spanish Society of Rheumatology on the use of biological therapies in rheumatoid arthritis.
abstract: OBJECTIVE
  To establish recommendations for the management of patients with rheumatoid arthritis (RA) to serve as a reference for all health professionals involved in the care of these patients, and focusing on the role of available synthetic and biologic disease-modifying antirheumatic drugs (DMARDs).
  
  
  METHODS
  Consensual recommendations were agreed on by a panel of 14 experts selected by the Spanish Society of Rheumatology (SER). The available scientific evidence was collected by updating three systematic reviews (SR) used for the EULAR 2013 recommendations. A new SR was added to answer an additional question. The literature review of the scientific evidence was made by the SER reviewer's group. The level of evidence and the degree of recommendation was classified according to the Oxford Centre for Evidence-Based Medicine system. A Delphi panel was used to evaluate the level of agreement between panellists (strength of recommendation).
  
  
  RESULTS
  Thirteen recommendations for the management of adult RA were emitted. The therapeutic objective should be to treat patients in the early phases of the disease with the aim of achieving clinical remission, with methotrexate playing a central role in the therapeutic strategy of RA as the reference synthetic DMARD. Indications for biologic DMARDs were updated and the concept of the optimization of biologicals was introduced.
  
  
  CONCLUSIONS
  We present the fifth update of the SER recommendations for the management of RA with synthetic and biologic DMARDs.
authors.affiliation: Servicio de Reumatología, Hospital Clínic de Barcelona, Barcelona, España. Electronic address: sanmarti@clinic.ub.es.
authors.forename: Raimon
authors.initials: R
authors.lastname: Sanmartí
authors.affiliation: Unidad de Investigación, Sociedad Española de Reumatología, Madrid, España.
authors.forename: Susana
authors.initials: S
authors.lastname: García-Rodríguez
authors.affiliation: Servicio de Reumatología, Hospital Universitario de la Princesa, Madrid, España.
authors.forename: José María
authors.initials: JM
authors.lastname: Álvaro-Gracia
authors.affiliation: Servicio de Reumatología, Hospital Universitario Puerta de Hierro, Madrid, España.
authors.forename: José Luis
authors.initials: JL
authors.lastname: Andreu
authors.affiliation: Servicio de Reumatología, Hospital Universitario La Paz, Madrid, España.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Balsa
authors.affiliation: Servicio de Reumatología, Hospital Universitario Virgen de las Nieves, Granada, España.
authors.forename: Rafael
authors.initials: R
authors.lastname: Cáliz
authors.affiliation: Unidad de Gestión Clínica de Reumatología, Instituto de Investigación Biomédica de Málaga, Hospital Regional Universitario de Málaga, Universidad de Málaga, Málaga, España.
authors.forename: Antonio
authors.initials: A
authors.lastname: Fernández-Nebro
authors.affiliation: Servicio de Reumatología, Hospital Universitario de Canarias, Tenerife, España.
authors.forename: Iván
authors.initials: I
authors.lastname: Ferraz-Amaro
authors.affiliation: Servicio de Reumatología, Hospital Clínico Universitario de Santiago, Santiago de Compostela, A Coruña, España.
authors.forename: Juan Jesús
authors.initials: JJ
authors.lastname: Gómez-Reino
authors.affiliation: Servicio de Reumatología, Hospital Universitario de la Princesa, Madrid, España.
authors.forename: Isidoro
authors.initials: I
authors.lastname: González-Álvaro
authors.affiliation: Servicio de Reumatología, Hospital Universitario La Paz, Madrid, España.
authors.forename: Emilio
authors.initials: E
authors.lastname: Martín-Mola
authors.affiliation: Servicio de Reumatología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, España.
authors.forename: Víctor Manuel
authors.initials: VM
authors.lastname: Martínez-Taboada
authors.affiliation: Servicio de Reumatología, Hospital Universitario de la Princesa, Madrid, España.
authors.forename: Ana M
authors.initials: AM
authors.lastname: Ortiz
authors.affiliation: Servicio de Reumatología, Hospital Universitario de Guadalajara, Guadalajara, España.
authors.forename: Jesús
authors.initials: J
authors.lastname: Tornero
authors.affiliation: Servicio de Reumatología, Hospital Universitario Vall d́Hebron, Barcelona, España.
authors.forename: Sara
authors.initials: S
authors.lastname: Marsal
authors.affiliation: Servicio de Reumatología, Hospital Universitario Vall d́Hebron, Barcelona, España; Sociedad Española de Reumatología, Madrid, España.
authors.forename: José Vicente
authors.initials: JV
authors.lastname: Moreno-Muelas
mesh_terms: D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D001685:Biological Factors / Q000627:therapeutic use*; D001691:Biological Therapy / Q000379:methods*; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D006801:Humans; D012219:Rheumatology; D012955:Societies, Medical; D013030:Spain
chemical_list: D018501:Antirheumatic Agents; D001685:Biological Factors
keywords: Artritis reumatoide; Biologic DMARD; Disease management; FAME biológico; FAME sintético; Manejo de la enfermedad; Recomendaciones; Recommendations; Rheumatoid arthritis; Sociedad Española de Reumatología; Spanish Society of Rheumatology; Synthetic DMARD