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Portuguese guidelines for the use of biological agents in rheumatoid arthritis - March 2010 update. 2010
João Eurico Fonseca, and
Helena Canhão, and
Paulo Reis, and
Maria José Santos, and
Jaime Branco, and
Alberto Quintal, and
Armando Malcata, and
Domingos Araújo, and
Francisco Ventura, and
Guilherme Figueiredo, and
José Canas da Silva, and
José Vaz Patto, and
Mário Viana de Queiroz, and
Rui André Santos, and
Adriano José Neto, and
Alves de de Matos, and
Ana Rodrigues, and
Ana Filipa Mourão, and
Ana Sofia Ribeiro, and
Ana Rita Cravo, and
Anabela Barcelos, and
Anabela Cardoso, and
António Vilar, and
Arecili Braña, and
Augusto Faustino, and
Candida Silva, and
Fátima Godinho, and
Inês Cunha, and
José António Costa, and
José António Melo Gomes, and
José António Araújo Pinto, and
J A Pereira da Silva, and
Luís Cunha Miranda, and
Luís Inês, and
Luís Maurício Santos, and
Margarida Cruz, and
Maria João Salvador, and
Maria Júlia Ferreira, and
Maria Rial, and
Miguel Bernardes, and
Mónica Bogas, and
Paula Araújo, and
Pedro Machado, and
Patrícia Pinto, and
Rui Gomes de Melo, and
Sara Cortes, and
Sérgio Alcino, and
Susana Capela, and
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).
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