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Article Excerpt
Most patients with a confirmed diagnosis of rheumatoid arthritis (RA) use nonbiologic disease-modifying antirheumatic drugs (DMARDs), and the rate of biologic DMARD use is increasing rapidly, according to the American College of Rheumatology (ACR). The organization last updated recommendations for the use of nonbiologic DMARDs in 2002 and had not developed recommendations for using biologic agents. Recently, however, the ACR issued new and revised recommendations that address the use of both types of therapies in patients with RA when they are starting or resuming them.
A Core Expert Panel of clinicians and methodologists used an evidence-based approach with an extensive literature review in guiding development of the recommendations for the use of DMARDs in RA. The ACR prespecified the following 5 key areas of therapy: (1) indications for use, (2) screening for tuberculosis, (3) monitoring for adverse effects, (4) assessing the clinical response, and (5) the roles of cost and patient preference in decision making. Also considered were disease duration, disease severity, and prognostic features. The ACR's 2008 recommendations for the use of nonbiologic and biologic DMARDs in RA include the following:
* Patients with all disease durations and all degrees of...
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