This guidance recommends adalimumab, etanercept and infliximab as possible treatments for people with rheumatoid arthritis who:

  • have already tried methotrexate and another disease-modifying anti-rheumatic drug (DMARD), and
  • have 'active' rheumatoid arthritis, as assessed by a rheumatologist on two separate occasions. People who are treated with adalimumab, etanercept or infliximab should normally also be given methotrexate. If methotrexate does not suit them, they may be given adalimumab or etanercept on its own.

This guidance partially updates and replaces NICE technology appraisal 36 (published in March 2002). This review and re-appraisal has additionally included adalimumab for the treatment of rheumatoid arthritis, and has taken into account changes in the marketing authorisations for infliximab and etanercept.