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dc.contributor.authorMota, Licia Maria Henrique dapt_BR
dc.contributor.authorKakehasi, Adriana Mariapt_BR
dc.contributor.authorReis, Ana Paula Monteiro Gomidespt_BR
dc.contributor.authorDuarte, Angela Luzia B. Pintopt_BR
dc.contributor.authorCruz, Boris Afonsopt_BR
dc.contributor.authorBrenol, Claiton Viegaspt_BR
dc.contributor.authorAlbuquerque, Cleandro Pires dept_BR
dc.contributor.authorPinheiro, Geraldo da Rocha Castelarpt_BR
dc.contributor.authorLaurindo, Iêda Maria Magalhãespt_BR
dc.contributor.authorPereira, Ivânio Alvespt_BR
dc.contributor.authorBertolo, Manoel Barrospt_BR
dc.contributor.authorSouza, Mariana Peixoto Guimarães Ubirajara e Silva dept_BR
dc.contributor.authorFreitas, Max Victor Carioca dept_BR
dc.contributor.authorLouzada Junior, Paulopt_BR
dc.contributor.authorXavier, Ricardo Machadopt_BR
dc.contributor.authorGiorgi, Rina Dalva Neubarthpt_BR
dc.date.accessioned2018-07-31T02:33:47Zpt_BR
dc.date.issued2018pt_BR
dc.identifier.issn2523-3106pt_BR
dc.identifier.urihttp://hdl.handle.net/10183/180868pt_BR
dc.description.abstractThe objective of this document is to provide a comprehensive update of the recommendations of Brazilian Society of Rheumatology on drug treatment of rheumatoid arthritis (RA), based on a systematic literature review and on the opinion of a panel of rheumatologists. Four general principles and eleven recommendations were approved. General principles: RA treatment should (1) preferably consist of a multidisciplinary approach coordinated by a rheumatologist, (2) include counseling on lifestyle habits, strict control of comorbidities, and updates of the vaccination record, (3) be based on decisions shared by the patient and the physician after clarification about the disease and the available therapeutic options; (4) the goal is sustained clinical remission or, when this is not feasible, low disease activity. Recommendations: (1) the first line of treatment should be a csDMARD, started as soon as the diagnosis of RA is established; (2) methotrexate (MTX) is the first-choice csDMARD; (3) the combination of two or more csDMARDs, including MTX, may be used as the first line of treatment; (4) after failure of first-line therapy with MTX, the therapeutic strategies include combining MTX with another csDMARD (leflunomide), with two csDMARDs (hydroxychloroquine and sulfasalazine), or switching MTX for another csDMARD (leflunomide or sulfasalazine) alone; (5) after failure of two schemes with csDMARDs, a bDMARD may be preferably used or, alternatively a tsDMARD, preferably combined, in both cases, with a csDMARD; (6) the different bDMARDs in combination with MTX have similar efficacy, and therefore, the therapeutic choice should take into account the peculiarities of each drug in terms of safety and cost; (7) the combination of a bDMARD and MTX is preferred over the use of a bDMARD alone; (8) in case of failure of an initial treatment scheme with a bDMARD, a scheme with another bDMARD can be used; in cases of failure with a TNFi, a second bDMARD of the same class or with another mechanism of action is effective and safe; (9) tofacitinib can be used to treat RA after failure of bDMARD; (10) corticosteroids, preferably at low doses for the shortest possible time, should be considered during periods of disease activity, and the risk-benefit ratio should also be considered; (11) reducing or spacing out bDMARD doses is possible in patients in sustained remission.en
dc.format.mimetypeapplication/pdfpt_BR
dc.language.isoengpt_BR
dc.relation.ispartofAdvances in rheumatology. São Paulo. Vol. 58 (2018), 2, 17 p.pt_BR
dc.rightsOpen Accessen
dc.subjectAtitude frente à saúdept_BR
dc.subjectArtrite reumatóidept_BR
dc.subjectMedopt_BR
dc.subjectRevisãopt_BR
dc.title2017 recommendations of the Brazilian Society of Rheumatology for the pharmacological treatment of rheumatoid arthritispt_BR
dc.typeArtigo de periódicopt_BR
dc.identifier.nrb001072857pt_BR
dc.type.originEstrangeiropt_BR


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