Rheumatoid arthritis affects people's joints
People with rheumatoid arthritis should have access to a particular class of drugs limited, NHS advisers say.
The National Institute for Health and Clinical Excellence said patients in England and Wales should only be able to try one anti-TNF drug.
Currently, patients can move on to a second or third anti-TNF if their first drug stops working.
Arthritis charities estimate 40,000 people will be affected if the draft guidance is approved later this year.
Anti-TNF (anti-tumour necrosis factor alpha) therapy drugs - adalimunab, etanercept, infliximab - can slow the progress of disease and help to reduce symptoms such as joint pain, swelling, mobility and fatigue.
Each drug works and is administered in slightly different ways.
NICE said that giving patients two, or even three, anti-TNFs is not cost-effective and that doctors should offer patients the next drug in line - rituximab - which costs about £3,000 less per year than the cheapest anti-TNF.
However, around a quarter of patients do not gain any benefit from rituximab.
'One roll of the dice'
Arthritis charities said that cutting the anti-TNF options from three to one, combined with a decision earlier this year to reject another arthritis drug for NHS use means patients' treatment choices will be severely limited.
And they said thousands could be left with no effective way of managing their condition.
The National Rheumatoid Arthritis Society warned that patients could face high levels of pain and the possibility of surgery and long term disability.
Chief executive Ailsa Bosworth said: "NICE are re-writing the rules of rheumatoid arthritis treatment in this country ignoring the clinical effectiveness of drugs and ignoring the views of patients and clinicians."
Ms Bosworth, who has had rheumatoid arthritis for almost 30 years and is now on her third anti-TNF drug, added: "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."
Abigail Page, head of policy and campaigns at Arthritis Care, said: "It is short-sighted and pernicious that NICE can look only at cost to the NHS, not at total cost to the taxpayer in terms of benefits and social care. It is rationing without rationality.
"When will the government do the maths and see that treating someone is often far cheaper than not treating them?"
Rob Moots, of the umbrella group Arthritis and Musculoskeletal Alliance and a professor of rheumatology at Liverpool University, said: "It's almost impossible to know which anti-TNF will work for a patient at the outset.
"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."
This is the second time NICE has said access to anti-TNFs should be limited.
It originally ruled that patients should only have one anti-TNF in 2006, but the decision was criticised by charities and the Royal College of Nursing and the watchdog agreed to review it last year.
NICE said the final guidance which will compel the NHS to act will probably be published in September.
It will cover England and Wales, but the Scottish equivalent of NICE is likely to follow suit.