American College of Rheumatology 2008Recommendations for the Use of Nonbiologic andBiologic Disease-Modifying Antirheumatic Drugsin Rheumatoid ArthritisKENNETH G. SAAG,1GIM GEE TENG,1NIVEDITA M. PATKAR,1JEREMY ANUNTIYO,2CATHERINE FINNEY,2JEFFREY R. CURTIS,1HAROLD E. PAULUS,2AMY MUDANO,1MARIA PISU,1MARY ELKINS-MELTON,1RYAN OUTMAN,1JEROAN J. ALLISON,1MARIA SUAREZ ALMAZOR,3S. LOUIS BRIDGES, JR.,1W. WINN CHATHAM,1MARC HOCHBERG,4CATHERINE MACLEAN,5TED MIKULS,6LARRY W. MORELAND,7JAMES O’DELL,5ANTHONY M. TURKIEWICZ,1ANDDANIEL E. FURST2Guidelines and recommendations developed and/or endorsed by the American College of Rheumatology (ACR) areintended to provide guidance for particular patterns of practice and not to dictate the care of a particular patient. TheACR considers adherence to these guidelines and recommendations to be voluntary, with the ultimate determinationregarding their application to be made by the physician in light of each patient’s individual circumstances.Guidelines and recommendations are intended to promote beneficial or desirable outcomes but cannot guarantee anyspecific outcome. Guidelines and recommendations developed or endorsed by the ACR are subject to periodicrevision as warranted by the evolution of medical knowledge, technology, and practice.IntroductionThe majority of patients with a confirmed diagnosis ofrheumatoid arthritis (RA) use nonbiologic disease-modify-ing antirheumatic drugs (DMARDs) and the rate of biologicDMARD use is rising rapidly (1,2). The American Collegeof Rheumatology (ACR) has not updated its recommenda-Dr. Saag’s work was supported by the Agency for Health-care Research and Quality (grant U18-H510389), the Uni-versity of Alabama, Birmingham Center for Education andResearch on Therapeutics of Musculoskeletal Diseases, anda grant from the American College of Rheumatology. Drs.Pisu, Allison, and Moreland’s work was supported by agrant from the American College of Rheumatology. Dr.Furst’s work was supported by a grant from the AmericanCollege of Rheumatology and the NIH.1Kenneth G. Saag, MD, MSc, Gim Gee Teng, MD, NiveditaM. Patkar, MD, MSPH, Jeffrey R. Curtis, MD, MPH, AmyMudano, MPH (current address: Blue Cross and Blue Shieldof Alabama, Birmingham), Maria Pisu, PhD, Mary Elkins-Melton, BA, Ryan Outman, MS, Jeroan J. Allison, MD, MS,S. Louis Bridges, Jr., MD, PhD, W. Winn Chatham, MD,Anthony M. Turkiewicz, MD: University of Alabama, Bir-mingham;Harold E. Paulus, MD, Daniel E. Furst, MD: University ofCalifornia, Los Angeles;3Maria Suarez Almazor, MD, MPH:University of Texas, MD Anderson, Houston;4Marc Hoch-berg, MD, MPH: University of Maryland, Baltimore;5Cathe-rine MacLean, MD, PhD, James O’Dell, MD: University ofCalifornia, Los Angeles, RAND Corporation, Santa Monica,and West Los Angeles VAMC;2Jeremy Anuntiyo, MD, Catherine Finney, MD,6Ted Mikuls, MD, MSPH:University of Nebraska, Omaha;7Larry W. Moreland, MD:University of Pittsburgh, Pittsburgh, Pennsylvania.Dr. Saag has received consultant fees (less than $10,000each) from Roche, UCB, Nitec, and Amgen and researchsupport from Abbott, Amgen, Centecor, Roche, and Wyeth.Dr. Curtis has received consultant fees, speaking fees,and/or honoraria (less than $10,000 each) from Roche,Merck, Procter and Gamble, Eli Lilly, UCB, and Novartisand research support from Amgen, Eli Lilly, Merck, Novar-tis, Procter and Gamble, and Roche. Dr. Paulus has receivedconsultant fees (less than $10,000 each) from Amgen, Rocheand Mathematica. Dr. Chatham has received speaking feesand honoraria (less than $10,000 each) from Bristol-MyersSquibb and Amgen. Dr. Hochberg has received consultantfees (less than $10,000 each) from Amgen and Bristol-MyersSquibb. Dr. MacLean owns stock and/or holds stock optionsin WellPoint. Dr. Mikuls has received speaking fees (lessthan $10,000 each) from Genentech and Amgen and unre-stricted grants from Abbott, Amgen, and Bristol-MyersSquibb. Dr. Moreland has received consultant fees, speakingfees, and/or honoraria (less than $10,000 each) from Roche,Bristol-Myers Squibb, Centocor, Pfizer, Amgen, Incyte, andGenentech. Dr. O’Dell has received consultant fees and speak-ing fees (less than $10,000) from Abbott. Dr. Turkiewicz hasreceived consultant fees and speaking fees (less than $10,000)Arthritis & Rheumatism (Arthritis Care & Research)Vol. 59, No. 6, June 15, 2008, pp 762–784DOI 10.1002/art.23721© 2008, American College of RheumatologySPECIAL ARTICLE762
