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The American College of Rheumatology (ACR) most recently published recommendations for the use of diseasemodifying  antirheumatic drugs (DMARDs) and biologic agents in the treatment of rheumatoid arthritis (RA) in 2008. These recommendations covered indications for use, monitoring of side effects, assessment of the clinical response to DMARDs and biologic agents, screening for tuberculosis (TB), and assessment of the roles of cost patient preference in decision making for biologic agents. Recognizing the rapidly evolving knowledge in RA management and the accumulation of new evidence regarding the safety and efficacy of existing and newer ther and thertherapies, the ACR commissioned an update of the 2008 recommendations in select topic areas.

The 2012 revision updates the 2008 ACR recommendations in the following areas: 1) indications for DMARDs and biologic agents, 2) switching between DMARD and biologic therapies, 3) use of biologic agents in high-risk patients (those with hepatitis, congestive heart failure [CHF], and malignancy), 4) screening for TB in patients starting or currently receiving biologic agents, and 5) vaccination in patients starting or currently receiving DMARDs or biologic agents.