Reachout Orthopedics - Issue 1

Practice Algorithm TREATMENT ALGORITHM OF RHEUMATOID ARTHRITIS 2017 Recommendations of the Brazillan Society of Rheumatology for pharmacological treatment of rheumatoid arthritis. 1: Sulfasalazine or leflunomide may be used in cases of contraindication to MTX. Antimalarials (hydroxychloroquine or chloroquine) as monotherapy may be considered in cases of low probability of development of radiographic erosions. 2: The most used combinations in Brazil are MTX + antimalarials, MTX + leflunomide (with or without antimalarials), MTX + sulfasalazine (with or without antimalarials). 3: The goal of treatment is remission according to ACR/EULAR criteria or, in cases where this is not possible, low disease activity, as assessed by one of the composite disease activity indices defined in the 2011 SBR Consensus (5). 4: The use of a third TNFi after failure of two TNFi drugs is not recommended. 5: In Brazil, rituximab is recommended in combination with methotrexate for patients with a poor response or intolerance to one or more TNFi drugs. 6: In case of failure or toxicity to a drug used in the third line of treatment, the next step is switching to another drug (bDMARD or tsDMARD) with the same level of complexity and that has not been used previously. Source: da Mota, L.M.H.., Kakehasi, A.M., Gomides, A.P.M. et al . 2017 recommendations of the Brazilian Society of Rheumatology for the pharmacological treatment of rheumatoid arthritis. Adv Rheumatol. 2018; 58: 2. DOI 10.1186/s42358-018-0005-0. © The Author(s) 2018. All rights reserved. No part of this publication may be reproduced, transmitted or stored in any form or by any means either mechanical or electronic, including photocopying, recording or through an information storage and retrieval system, without the written permission of the copyright holder. Although great care has been taken in compiling the content of this publication, the publisher and its servants are not responsible or in any way liable for the accuracy of the information, for any errors, omissions or inaccuracies, or for any consequences arising therefrom. Inclusion or exclusion of any product does not imply its use is either advocated or rejected. Use of trade names is for product identification only and does not imply endorsement. Opinions expressed do not necessarily reflect the views of the Publisher, Editor, Editorial Board or Authors. The image/s used on the cover page and page no 2, 8, 13, 16, 18, 21, 23, 28, 29 have been obtained from Shutterstock/Fotolia under a valid license to use as per their policy. The images used are representational and not of actual health care professional (HCP) or patient. Please consult the latest prescribing information from the manufacturer before issuing prescriptions for any products mentioned in this publication. The product advertisements published in this reprint have been provided by the respective pharmaceutical company and the publisher and its servants are not responsible for the accuracy of the information. © Springer Healthcare 2019 February 2019 This edition is created in India for free distribution in India. This edition is published by Springer Nature India Private Limited. Registered Office: 7th Floor, Vijaya Building, 17, Barakhamba Road, New Delhi 110 001, India. 91 (0) 11 4575 5888 www.springerhealthcare.com Part of the Springer Nature group 31