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Revista Cubana de Reumatología

versión On-line ISSN 1817-5996

Resumen

TOLEDANO ZM, Guibert  y  ZOILA MARLENE GUIBERT TOLEDANO,1* WITJAL MANUEL BERMUDEZ MARRERO, ALFREDO ANTONIO HERNANDEZ MARTINEZ, RICARDO MORASEN CUEVAS, GIL ALBERTO REYES LLERENA, MIGUEL HERNAN ESTEVEZ DEL TORO, ARACELIS CHICO CAPOTE, OSVALDO CALISTE MANZANO, EDUARDO BICET DORZON, ANA MARTA LOPEZ MANTECON, BEATRIZ BENITEZ CUEVAS, ISABEL LEYVA ALFARO, BERNARDO MARTINEZ DESPAIGNA, ZOE ALINA GONZALEZ OTERO, CELESTINO FUSTE JIMENEZ, RICARDO SUAREZ MARTIN, BARBARA LORENZA SUAREZ RODRIGUEZ, JORGE LUIS EGUES MESA, WONDERLY NEREY GONZALEZ, EUGENIO ALEJANDRO REYES MEDINA, JOSE PEDRO MARTINEZ LARRARTE, MERCEDES DEL CARMEN DE LEON CASTILLO, JESUS ALBERTO GONZALEZ LEMUS, EDUARDO DEL CAMPO AVILES, ADELAIDA GARCIA STEVENS, HALIE MIRABAL SANCHEZ, YANILEYDYS HERNANDEZ MUNIS, MABEL CABALLE FERREIRA, RAFAEL GIL ARMENTEROS, YUSIMI REYES PINEDA, SANTA YARELIS GOMEZ CONDE, MARIA DEL CARMEN BLANCO DE LA PORTILLA, MARGARITA HERNANDEZ GARCIA, ZUZEL FIGUEROA PUENTE, DOLORES CANTERA OCEGUERA, ELSI CHALL RODRIGUEZ, CECILIA COTO HERMOSILLA, YANET RODRIGUEZ ZULUETA, SILVIA MARIA POZO ABREU et al. First Cuban consensus on the use of conventional and biological therapy in patients with rheumatoid arthritis. Rev Cuba Reumatol [online]. 2021, vol.23, n.3  Epub 01-Abr-2022. ISSN 1817-5996.

Introduction:

The development of recommendations for the treatment of rheumatoid arthritis (RA) in the Cuban context may be one of the ways to achieve better control of this disease.

Objective:

To reach a consensus and update relevant aspects of conventional and biological RA modifier therapy in Cuba.

Methods:

18 specialists from 8 Cuban provinces, experts in RA care, were summoned, according to the years of dedication to the specialty, the conferences on this topic and their publications. The first meeting took place in March 2016 in the provincial hospital of Villa Clara, Cuba, with the participation of all the experts. A review of the literature on conventional and biological therapy previously collected by the participants was developed, and two teams were formed: the first would address everything related to conventional therapy in RA (HRCT) and the other, biological therapy in RA (TBAR). Three questionnaires related to the use of corticosteroids, HRCT and TBAR, were prepared, answered by the participants via email. In a second meeting, held in October 2016 in Havana, the analysis of all the responses provided was carried out. Questions with a response of 90% or more votes were considered as recommendations.

Results:

The questionnaires were answered by 95% of the participants. 9 recommendations and 1 algorithm were established. The recommendations are as follows: methotrexate is the drug of choice in the treatment of RA after diagnosis; The administration of another conventional drug (DMARDc) (azathioprine, salazosulfapyridine, antimalarials and leflunomide) is recommended in patients with a diagnosis of active RA in whom methotrexate is contraindicated or there is a failure in response - consider the administration of low doses of prednisone or equivalent (<7.5 mg/d) associated with DMARDc in patients with active moderate to severe RA, for the shortest possible time; perform serological control including tests for hepatitis B and C viruses and screening for HIV in all patients diagnosed with RA before starting treatment with DMARDc and biologics; in patients in remission or, at least, with a DAS-28 below 3.2, consideration should be given to withdrawing one of the DMARDs or reducing, to the minimum possible expression, the dose of both disease modifiers; if methotrexate fails, tocilizumab in combination with methotrexate or as monotherapy will be indicated.

Conclusions:

Aspects related to conventional therapy with methotrexate, azathioprine, salazosulfapyridine, antimalarials and leflunomide were agreed. The value of early diagnosis and immediate initiation of DMARDc therapy and the use of glucocorticoids was analyzed. Treatment with tocilizumab, the only biological available in Cuba against RA, will be administered when there is a failure in the response to conventional therapy and combinations between these drugs. It is recommended to hold educational conferences through the mass media aimed at patients.

Palabras clave : rheumatoid arthritis; Cuban consensus; biological therapy in Cuba.

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