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Most of the changes in the 2012 revision reflect treatment lessons learned as biologic response modifier therapies have become better known (Table 1). The 2012 guidelines added another non- TNF biologic, tocilizumab (which blocks the IL-6 messenger cytokine), and two additional anti-TNFs, certolizumab pegol and golimumab. The 2012 guidelines focus on use of both DMARDs and biologics, making recommendations regarding selection of and switches between these agents.
An important addition in the 2012 revision is an update focused on safety issues that have become more apparent over time. Contemporary disease modifying antirheumatic drugs (DMARD) in patients with recent onset rheumatoid arthritis in a US private practice: methotrexate as the anchor drug in 90% and new DMARD in 30% of patients. Treatment of rheumatoid arthritis with methotrexate alone, sulfasalazine and hydroxychloroquine, or a combination of all three medications.
Anti-Tumor Necrosis Factor Trial in Rheumatoid Arthritis with Concomitant Therapy Study Group.
Infliximab (chimeric anti-tumour necrosis factor alpha monoclonal antibody) versus placebo in rheumatoid arthritis patients receiving concomitant methotrexate: a randomised phase III trial. A trial of etanercept, a recombinant tumor necrosis factor receptor:Fc fusion protein, in patients with rheumatoid arthritis receiving methotrexate. Direct medical costs and their predictors in patients with rheumatoid arthritis: a three-year study of 7,527 patients.

Treatment with leflunomide slows radiographic progression of rheumatoid arthritis: results from three randomized controlled trials of leflunomide in patients with active rheumatoid arthritis. Radiological and clinical results of longterm treatment of rheumatoid arthritis with methotrexate and azathioprine. The effect of folic acid supplementation on the toxicity of low-dose methotrexate in patients with rheumatoid arthritis.
Consequently, the 2012 guideline revisions from the American College of Rheumatology (ACR) follow just four years after the previous version in 2008. Excess levels of TNF are associated with inflammatory diseases such as rheumatoid arthritis, plaque psoriasis, psoriatic arthritis, juvenile idiopathic arthritis, and ankylosing spondylitis.
These were published in the April issue of Arthritis Care & Research and are on the website (www.
These guidelines were published in the June issue of Arthritis Care & Research and are available on the ACR website. 2012 Update of the 2008 American College of Rheumatology Recommendations for the Use of Disease-Modifying Antirheumatic Drugs and Biologic Agents in the Treatment of Rheumatoid Arthritis. IntroductionSmall molecule disease-modifying antirheumatic drugs (DMARDs) played a central role in drug therapy for rheumatoid arthritis (RA) before biological preparations (biologics) came into extensive use for the treatment of this disease. Evidence for differential acquired drug resistance to anti-tumour necrosis factor agents in rheumatoid arthritis.

Drug-specific risk of tuberculosis in patients with rheumatoid arthritis treated with anti-TNF therapy: results from the British Society for Rheumatology Biologics Register (BSRBR). The registry delivers information based on local population management; it is integrated with national qualitycare programs and contains quality measures aimed at improving care and drug safety for patients with rheumatoid arthritis, osteoarthritis, osteoporosis, gout, and juvenile idiopathic arthritis.
In 2002, the American College of Rheumatology (ACR) released its Guidelines on RA Management, clearly indicating DMARDs as first-line drugs for the treatment of RA. Current standard of care for RA It has been shown that intervention with biologics at early stages of RA is expected to control the disease activity and suppress subsequent joint destruction, thus facilitating remission of RA, biologics free and cure [52]. It has thus been suggested to be more important to practice tight control through adjusting treatment flexibly depending on the disease activity in individual cases, instead of selecting biologics from the beginning (Figure 4).In 2012, the ACR published the "2012 Update of the 2008 American College of Rheumatology Recommendations for the Use of Disease-Modifying Antirheumatic Drugs and Biologic Agents in the Treatment of Rheumatoid Arthritis," and recommended separate methods of treatment for patients at early stages of RA (less than 6 months after onset) and patients with established RA (6 months or more after onset) [18]. In May 2012, the US FDA issued an approval recommendation for the use of this drug in adults with moderate or severe RA.

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