2012 Brazilian Society of Rheumatology consensus for the treatment of rheumatoid arthritis

• Autor(a) principal: Pereira, Ivânio Alves
• Data de Publicação: 2012
• Outros Autores: Mota, Licia Maria Henrique da, Cruz, Boris Afonso, Brenol, Claiton Viegas, Fronza, Lucila Stange Rezende, Bertolo, Manoel Barros, Freitas, Max Victor Carioca de, Silva, Nilzio Antonio da, Louzada Junior, Paulo, Giorgi, Rina Dalva Neubarth, Lima, Rodrigo Aires Corrêa, Pinheiro, Geraldo da Rocha Castelar
• Tipo de documento: Artigo
• Idioma: eng
• Título da fonte: Repositório Institucional da UFRGS
• Texto Completo: http://hdl.handle.net/10183/146998
• topic: Artrite reumatóide; Consenso; Terapêutica; Rheumatoid arthritis; Therapy; Brazil; Antirheumatic agents; Consensus

Objective: To elaborate recommendations for the treatment of rheumatoid arthritis in Brazil. Method: Literature review with articles’ selection based on evidence and the expert opinion of the Rheumatoid Arthritis Committee of the Brazilian Society of Rheumatology. Results and conclusions: 1) The therapeutic decision should be shared with the patient; 2) immediately after the diagnosis, a disease-modifying antirheumatic drug (DMARD) should be prescribed, and the treatment adjusted to achieve remission; 3) treatment should be conducted by a rheumatologist; 4) the initial treatment includes synthetic DMARDs; 5) methotrexate is the drug of choice; 6) patients who fail to respond after two schedules of synthetic DMARDs should be assessed for the use of biologic DMARDs; 7) exceptionally, biologic DMARDs can be considered earlier; 8) anti-TNF agents are preferentially recommended as the initial biologic therapy; 9) after therapeutic failure of a fi rst biologic DMARD, other biologics can be used; 10) cyclophosphamide and azathioprine can be used in severe extra-articular manifestations; 11) oral corticoid is recommended at low doses and for short periods of time; 12) non-steroidal anti-infl ammatory drugs should always be prescribed in association with a DMARD; 13) clinical assessments should be performed on a monthly basis at the beginning of treatment; 14) physical therapy, rehabilitation, and occupational therapy are indicated; 15) surgical treatment is recommended to correct sequelae; 16) alternative therapy does not replace traditional therapy; 17) family planning is recommended; 18) the active search and management of comorbidities are recommended; 19) the patient’s vaccination status should be recorded and updated; 20) endemic-epidemic transmissible diseases should be investigated and treated.