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 USA, Canada, and Europe. Pharmaceutical industry support was obtained from a number of companies, but these institutions had no part in the decisions about the specific programme or about the academic participants at this conference. Further, they did not participate in the preparation or writing of this document. The perspective of this consensus is from the treating physician’s point of view.

The 140 rheumatologists and bioscientists who attended the consensus conference were chosen from a worldwide group of physicians and other scientists from 19 countries. They had 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 last 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, as well as 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 3. 2 As the number of possible references has become so large, reviews were sometimes used and, if they contained A level references, are referred to as A level evidence. All participants reviewed relevant clinical published articles relating to tumour necrosis factor (TNF) and interleukin (IL)-1 blocking agents. They were given a draft consensus statement and were asked to revise the document in small discussion groups; open discussion of the revisions led to a final document, representing this updated consensus statement.