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Table 1 Questions based on clinical scenarios, selected by the rheumatoid arthritis committee of the brazilian society of rheumatology to guide the development of the recommendations

From: 2017 recommendations of the Brazilian Society of Rheumatology for the pharmacological treatment of rheumatoid arthritis

Questions about possible clinical scenarios for treating rheumatoid arthritis in Brazil, considering safety, effectiveness, and cost.
Question 1: Should the first line of treatment be csDMARD (methotrexate, hydroxychloroquine, leflunomide, or sulfasalazine), tsDMARD (tofacitinib), or bDMARD (adalimumab, certolizumab, etanercept, infliximab, golimumab, abatacept, rituximab, or tocilizumab)?
Question 2: Is there evidence that a particular csDMARD is more effective than other csDMARDs?
Question 3: Is there evidence that the use of combination therapy with two or more csDMARDs is more effective than csDMARD monotherapy as the first line of treatment?
Question 4: Is there evidence that after failure of a csDMARD monotherapy as the first line of treatment, the best option is to switch to a second monotherapy regimen rather than using combination therapy with two or more csDMARDs?
Question 5: Is there evidence that a particular TNFi (adalimumab, certolizumab, etanercept, golimumab, or infliximab) or non-TNFi (abatacept, rituximab, or tocilizumab) bDMARD is more effective than other biological agents?
Question 6: Is there evidence that bDMARD (adalimumab, certolizumab, etanercept, golimumab, infliximab, abatacept, rituximab, or tocilizumab) combined with methotrexate is more effective than bDMARD monotherapy?
Question 7: In the case of failure of a first bDMARD scheme, is there evidence that a second bDMARD scheme is effective?
Question 8: Is there evidence that tsDMARD (tofacitinib) is more effective than bDMARD (adalimumab, certolizumab, etanercept, golimumab, infliximab, abatacept, rituximab, or tocilizumab)?
Question 9: Is there evidence that oral, parenteral, or intra-articular use of corticosteroids improves prognosis when combined with DMARD?
Question 10: Is there evidence that it is possible to reduce the dose or increase the dose intervals for bDMARD in patients in remission?
  1. csDMARD conventional synthetic disease-modifying drugs – methotrexate, leflunomide, sulfasalazine and antimalarials (hydroxychloroquine and chloroquine)
  2. tsDMARD: synthetic target-specific disease-modifying drugs – tofacitinib
  3. bDMARD: biological disease-modifying drugs – tumor necrosis factor inhibitors/TNFi (adalimumab, certolizumab, etanercept, golimumab, infliximab), T-lymphocyte costimulation modulator (abatacept), anti-CD20 (rituximab), and IL-6 receptor blocker (tocilizumab)