American college of rheumatology presents recommendations for rheumatoid arthritis therapy To manage the painful and incapacitating symptoms of rheumatoid arthritis(Ra), a chronic, inflammatory joint disease, the majority of patients rely on diseasemodifying antirheumatic drugs(Dmards).In addition to trusted nonbiologic dmards, a number of biologic agents now promise to improve treatment for ra.The american college of rheumatology(Acr), respected worldwide for its devotion to fostering excellence in patient care, has not updated recommendations for nonbiologic DMARDs since 2002 and has not previously developed recommendations for biologic agents.In view of that, acr decided it was time for a major reevaluation of the use of dmard therapy in rheumatoid arthritis.High disease activity)The roles of cost and patient preference in choosing biologic agents.When developing these recommendations, ra disease duration, disease severity, and prognostic features were also considered. "Applying these recommendations to clinical practice requires individualized patient assessment and clinical decisionmaking.The recommendations developed are not intended to be used in a 'cookbook' or prescriptive manner or to limit a physicians clinical judgment, but rather to provide guidance based on clinical evidence and expert panel input. " The acr 2008 recommendations for nonbiologic and biologic dmard use in ra include: Initiating methotrexate or leflunomide therapy was recommended for most ra patients. Methotrexate plus hydroxychloroquine was endorsed for patients with moderate to high disease activity. The triple dmard combination of methotrexate plus hydroxychloroquine plus sulfasalazine for patients with poor prognostic features and beats by dre solo hd moderate to high levels of disease activity. Prescribing antitnf agents etanercept, infliximab, or adalimumab along with methotrexate chpdrebtshdphones in early ra(Less than 3 months)Only for patients with high disease activity who had never received dmards.In intermediate and longerduration ra, antitnf agents were recommended for patients who had failed to respond adequately to methotrexate therapy. Reserving the fusion protein abatacept and the bcell antibody(Rituximab)For patients with at least moderate disease activity and poor disease prognosis for whom methotrexate in combination with or sequential administration of other nonbiologic dmards led to an inadequate response. Avoiding the initiation or resumption of treatment with methotrexate, leflunomide, or beats by dre online store uk biologic agents for patients with active bacterial infection, active herpeszoster viral infection, active or latent tuberculosis, or acute or chronic hepatitis b or c. Not prescribing antitnf agents to patients with a history of heart failure, with a history of lymphoma, or with multiple sclerosis or demyelinating disorders. Avoiding the initiation or resumption of methotrexate, leflunomide, or minocycline for ra patients planning for pregnancy and throughout the duration of pregnancy and breastfeeding. "These recommendations are extensive but not comprehensive,"Dr.Saag acknowledges,"And it is intended that they will be regularly updated to reflect the rapidly growing scientific evidence in this area along with changing practice patterns in rheumatology. "Article: "American College of Rheumatology 2008 Recommendations for the Use of Nonbiologic and Biologic Disease Modifying AntirheumaticDrugs in Rheumatoid Arthritis, "Kenneth g.Saag, gim gee teng, nivedita m.Patkar, jeremy anuntiyo, catherine finney, jeffrey r.Curtis, harold e.Paulus, amy mudano, maria pisu, mary elkinsmelton, ryan outman, jeroan j.Allison, maria suarez almazor, s.Louis bridges, jr., W.Winn chatham, marc hochberg, catherine maclean, ted mikuls, larry w.Moreland, james odell, anthony m.Turkiewicz, and daniel e.Furst, arthritis rheumatism(Arthritis care research), June 15, 2008;59:6, pp.762784.