As in previous years, the consensus group to consider the use of biological agents was constituted by rheumatologists from the universities of Erlangen, Leiden, and Vienna in Europe in cooperation with other universities in the United States, Canada, and Europe. Pharmaceutical industry support was obtained from a number of companies, but the institutions had no part in the decisions regarding the specific programme or about the academic participants at this conference. These sponsors participated in the initial small break-out groups with emphasis on supplying factual information. The companies, on the other hand, had no part in the larger, final consensus group or in the final consensus statement.

The perspective of this consensus is from the treating physician’s point of view.

The 143 rheumatologists and bioscientists who attended the consensus conference were chosen from a worldwide group of physicians and other scientists from 21 countries, with expertise in the use of biological agents for the treatment of rheumatic diseases. The number of attendees and participants was limited so that not everyone who might have been interested could be invited.

Additional information has come to light in the past year, both corroborating the major positive effect these drugs have had in rheumatoid arthritis (RA), psoriatic arthritis (PsA), ankylosing spondylitis (AS), and other rheumatic diseases, and further documenting adverse events. Therefore an update of the previous consensus statement is appropriate.¹ The consensus statement is annotated to document the credibility of the data supporting it as much as possible. This annotation is that of Shekelle et al and is described in appendix.² As the number of possible references has become so large, reviews are sometimes used and, if they contain category A references, will be referred to as category A evidence. All participants reviewed relevant clinical published articles relating to tumour necrosis …