New treatment guidelines for rheumatoid arthritis treatment published in US

Researchers from the US have recommended that doctors prescribe proven combinations of medicines and new anti-TNF drugs to patients suffering from rheumatoid arthritis (RA).

A team from the University of Alabama worked with the American College of Rheumatology to develop a new set of treatment guidelines for patients with RA.

Lead author Dr Kenneth Saag said that the new guidelines were not designed to replace individualised medical decisions, but instead provide information about successful strategies for treating RA with the goal of preventing joint damage and disability.

After reviewing research, the team suggested that methotrexate or leflunomide therapy should be recommended for most RA patients. They added that anti-TNF agents, such as etanercept, infliximab and adalimumab, could be prescribed along with methotrexate for new or early RA cases with worsening and severe symptoms.

Furthermore, the team said that medical professionals should not initiate or resume treatment with methotrexate, leflunomide, or biologics when a patient has an active bacterial infection, shingles, herpes, or latent tuberculosis.

Finally, they said that doctors should not be prescribing anti-TNF drugs to patients with a history of heart failure, lymphoma or multiple sclerosis.

Dr Saag explained: "The recommendations developed are not intended to be used in a 'cookbook' or prescriptive manner, or to limit a physician's clinical judgment.

"They provide guidance based on clinical evidence and expert panel input."

A spokesman for the Arthritis Research Campaign said that in the UK, under NICE guidelines only people with severe RA who had failed on either methotrexate or sulfasazine were eligible for anti-TNF therapy.

NICE announced earlier this week that patients who fail on the first anti-TNF therapy should not be able to try a second, unless they are taking part in a clinical trial.

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