The Role Of Biological Agents For Rheumatoid Arthritis: Best Evidence And Guidelines For Clinical Decision [uso De Agentes Biológicos Para O Tratamento Da Artrite Reumatóide: Melhores Evidências E Recomendações Para A Prática Clínica]

Abstract

Rheumatoid arthritis (RA) is a chronic, systemic, autoimmune disease of unknown etiology, which predominantly involves small joints and is more common in women. It has a high degree of morbidity and is an important health problem. The treatment of RA includes DMARDs (disease-modifying anti-rheumatic drugs) and more recently the so-called biological agents. Carry out a structured literature review to determine the best existing evidences in medical literature regarding the diagnosis and treatment of rheumatoid arthritis. Six questions on RA were prepared: 1) What are the diagnostic criteria for initial rheumatoid arthritis diagnosis?; 2) For patients with diagnosis of rheumatoid arthritis what are the prognosis markers and what are their clinical implications?; 3) For patients with rheumatoid arthritis, when should DMARDs (MTX, sulfasalazine, among others) be introduced? What is the initial choice drug?; 4) For patients with rheumatoid arthritis, when should biological agents be introduced? Should they be administered after the initial administration of methotrexate or at the time of diagnosis?; 5) What are the indications of the biological agents in early onset RA?; 6) Are biological agents effective and safe in the treatment of rheumatoid arthritis: Is there evidence of the relative superiority of any of the biological agents in terms of efficacy and safety? A structured literature review was carried out using different databases. In this review, the objective was to identify clinical studies which are methodologically more adequate that might respond to each of the questions. A committee of specialists evaluated literature data and prepared responses to each one of the questions. 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