Portuguese guide lines for the use of biological agents in rheumatoid arthritis - october 2011 update

João Eurico Fonseca, Miguel Bernardes, Helena Canhão, Maria José Santos, Alberto Quintal, Armando Malcata, Adriano Neto, Ana Cordeiro, Ana Rodrigues, Ana Filipa Mourão, Ana Sofia Ribeiro, Ana Rita Cravo, Anabela Barcelos, Anabela Cardoso, António Vilar, Arecili Braña, Armando Malcata, Augusto Faustino, Candida Silva, Cátia DuarteDomingos Araújo, Dolores Nour, Elsa Vieira-Sousa, Eugénia Simões, Fátima Godinho, Filipe Brandão, Francisco Ventura, Graça Sequeira, Guilherme Figueiredo, Inês Cunha, J. Alves de Matos, Jaime Branco, Maria João Ramos, José António Costa, José António Melo Gomes, José Pinto, José Canas da Silva, JA Pereira da Silva, José Vaz Patto, Lúcia Costa, Luís Cunha Miranda, Luís Sousa Inês, Luís Maurício Santos, Margarida Cruz, Maria João Salvador, Maria Júlia Ferreira, Maria Rial, Mário Viana Queiroz, Mónica Bogas, Paula Araújo, Paulo Reis, Pedro Abreu, Pedro Machado, Patrícia Pinto, Rui André, Rui Melo, Sandra Garcês, Sara Cortes, Sérgio Alcino, Sofia Ramiro, Susana Capela

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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 (with a tumour necrosis factor antagonist, abatacept or tocilizumab) should be considered in RA patients with a disease activity score 28 (DAS 28) equal to or greater than 3.2 des pite treatment with at least 20mg-weekly-dose of methotrexate (MTX) for at least 3 months or, if such treatment is not possible, after 3 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 regi -mens 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, defined 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 at least 0.6 in the DAS28 score. After 6 months of treatment res ponse criteria is defined as a decrease greater than 1.2 in the DAS28 score. Non-responders, in accordance to the Rheumatologist's clinical opi -nion, should try a switch to another biological agent (tumour necrosis factor antagonist, abatacept, rituxi mab or tocilizumab).

Original languageEnglish
Pages (from-to)385-388
Number of pages4
JournalActa Reumatológica Portuguesa
Issue number4
Publication statusPublished - Oct 2011


  • Biological Thera -pies
  • Guidelines
  • Rheumatoid arthritis


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