NHS patients should not be allowed to try a second inhibitor if their first attempt fails, the National Institute for Health and Clinical Excellence (Nice) has decided.
Charities said that could leave sufferers with pain and the possibility of long-term disability.
Trying different anti-TNF therapies (tumour necrosis factor alpha inhibitors) is common. The British Society for Rheumatology Biologics Register showed around 70% of patients will get a good response from a second anti-TNF if the effects of the first start to wane.
Now charities and patients' groups are preparing to appeal against NICE's ruling before final guidance is issued to the NHS in September.
Rob Moots, clinician for the Arthritis and Musculoskeletal Alliance, and professor of rheumatology at
"It's almost impossible to know which anti-TNF will work for a patient at the outset," he said.
"Before this decision we could try patients on each of the three treatments in turn to find one that was effective for them - now we only have one shot at success.
"Many patients will be left in astonishing pain, while knowing we haven't explored all the options for them."
Rheumatoid arthritis is an auto-immune disease for which there is no cure. It occurs when the immune system attacks the joints, causing swelling and damaging cartilage and bone.
Ailsa Bosworth, the chief executive of the National Rheumatoid Arthritis Society, said today's move, combined with a NICE decision in April to reject the drug abatacept, meant effective therapies had been cut from five to two.
For more reasons to be afraid, very afraid, of government healthcare, visit www.biggovhealth.org.
