Consenso 2012 da Sociedade Brasileira de Reumatologia para o tratamento da artrite reumatoide

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 first 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-inflammatory 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