Around 60,000 people in the UK with rheumatoid arthritis (RA) are being denied access to potentially life-changing drugs, charities said.
A decision by the National Institute for Health and Clinical Excellence (Nice) could leave sufferers with pain and the possibility of long-term disability.
Patients will not able able to try a second Anti-TNF (tumour necrosis factor alpha inhibitor) if their first attempt at Anti-TNF therapy fails, according to the Nice decision.
But charities said that moving from one therapy to a second or third has been established practice in the UK for years.
The British Society for Rheumatology Biologics Register shows that around 70% of patients will get a good response from a second Anti-TNF if the effects of the first start to wane.
Charities will have chance to appeal against today's decision before final guidance is issued to the NHS in September.
Ailsa Bosworth, 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.
She added: "This decision is another nail in the coffin for the treatment of RA in England and Wales.
"Nice are re-writing the rules of RA treatment in this country, ignoring the clinical effectiveness of drugs and ignoring the views of patients and clinicians.
"NICE is systematically taking away clinically effective and proven treatments from patients and giving them just one roll of the dice when it comes to Anti-TNF treatment."
