[Guidelines for the use of biologic therapies in rheumatoid arthritis--December 2006 update]

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 therapies were discussed as well as the contra-indications and procedures in case of non-responders. Biological treatment is indicated 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, refractory to 6 months of other conventional disease modifying drug or combination therapy. It is also considered the hypothesis of starting a biological treatment in RA patients treated by the previous regimes with a DAS28 score between 2,6 and 3,2 and a significative functional or radiological worsening. The follow-up should be performed each 3 months. The response criteria, at the end of the first 3 months of treatment, is a decrease of 0,6 in the DAS28 score. After 6 months of treatment response criteria is defined as follows: for those with an initial DAS28 score superior to 5,1, a reduction of the DAS28 score below 4 is required; for those with an initial DAS28 score inferior to 5,1, a reduction of the DAS28 score below 2,6 or between 2,6 and 3,2 without a significative functional or radiological worsening is required. Non-responders, in accordance to the Rheumatologist's clinical opinion, should try a switch to other tumour necrosis factor alpha antagonist or to rituximab.