New 2009 NICE clinical guideline for the treatment of rheumatoid arthritis

The UK’s National Institute for Health and Clinical Excellence (NICE) issued in February 2009 an update of the rheumatoid arthritis guideline.

Pharmacist Matt Robinson at his excellent “Prescribing advice for GP’s” commented the most relevant points of the guidance:

This guideline recommends that treatment is started early during active disease in order to minimise damage to joints.

A combination of disease-modifying anti-rheumatic drugs (DMARDs) including methotrexate and one other DMARD are recommended to be started within 3 months of the onset of persistent symptoms. In addition, a short course of a steroid is recommended to provide symptomatic relief during a flare.

The guideline also details the place in therapy for analgesics (including non-steroidal anti-inflammatory drugs), long-term steroids and biological agents.

Finally, the guideline recommends that people with rheumatoid arthritis are offered access to a multi-disciplinary team (MDT) including:

  • specialist occupational therapy if they have trouble with daily activities or hand function
  • specialist physiotherapy to improve general fitness, flexibility and strength
  • a podiatrist if they have particular foot problems

Action: Primary care clinicians should be aware of these new guidelines. Clinicians who see patients with rheumatoid arthritis will find this information useful.

Full PDF can be downloaded here: Rheumatoid arthritis. NICE guideline

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