Portuguese guidelines for the use of biological agents in rheumatoid arthritis--December 2007 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 agents are discussed as well as the contraindications and procedures in 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 follow-up should be performed each 3 months. 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 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 decrease of the DAS28 score below 3.2 without a significant functional or radiological worsening is required. Non-responders in accordance to the Rheumatologist s clinical opinion should try a switch to other biological agent tumour necrosis factor alpha antagonist rituximab or abatacept .