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. Author manuscript; available in PMC: 2013 Jul 10.
Published in final edited form as: Clin Ther. 2011 Jun;33(6):679–707. doi: 10.1016/j.clinthera.2011.05.044

Table VI.

Summary of 2008 ACR guidelines about biologic use in RA patients.14

RA disease duration RA disease activity Previous treatments failed Recommendation
<6 months High for 3–6 months – TNF antagonist plus MTX
High for <3 months, plus features of poor prognosis,a and no cost or insurance coverage limitations
≥6 months High MTX monotherapy TNF antagonist
Moderate, plus features of poor prognosis
≥6 months High MTX combination therapy With features of poor prognosis: TNF antagonists, abatacept, or rituximab (the latter only if disease activity is high)
Moderate Sequential administration of other nonbiologic DMARDs
Without features of poor prognosis: nonbiologic DMARD or TNF-antagonist
a

Features of poor prognosis include functional limitation (defined using standard measurement scales such as Health Assessment Questionnaire score), extra-articular disease (eg, presence of rheumatoid nodules, secondary Sjögren’s syndrome, RA vasculitis, Felty’s syndrome, and RA lung disease), rheumatoid factor positivity, positive anti-cyclic citrullinated peptide antibodies, or bony erosions on radiography.

ACR = American College of Rheumatology; DMARDs = disease-modifying anti-rheumatic drugs; MTX = methotrexate; RA = rheumatoid arthritis; TNF = tumor necrosis factor.