Thousands of people with rheumatoid arthritis are set to benefit from a new guideline to be published this week. The National Institute for Health and Clinical Excellence (NICE) and the National Collaborating Centre for Chronic Conditions will issue a guideline to improve the management of rheumatoid arthritis in adults. Available from 25 February, it will set out how best to identify rheumatoid arthritis, which treatments and therapies are effective, and when surgery should be considered.

Rheumatoid arthritis (RA) is a long-term disease in which joints in the body become inflamed, causing pain, swelling and stiffness. It often affects the small joints of the hands and the feet, and usually both sides equally and symmetrically. Around 400,000 people in the UK have RA and people of all ages can develop the disease. Over twice as many women as men suffer from the condition.

RA is known as an ‘autoimmune disease’ because it is caused when the body’s own immune system starts to attack healthy joints, in particular joints lined with the tissue called synovium. There is no cure, but a range of treatments can help. For example, drug treatments can give pain relief (a priority for most people with RA) and can modify the disease process which slows down progression of RA.

Recommendations from the guideline include:

- Refer for specialist opinion any person with suspected persistent synovitis of undetermined cause. Refer urgently if any of the following apply: the small joints of the hands or feet are affected; more than one joint is affected; there has been a delay of 3 months or longer between onset of symptoms and seeking medical advice

- In people with newly diagnosed active RA, offer a combination of disease modifying anti-rheumatic drugs – DMARDs – (including methotrexate and at least one other DMARD, plus short-term glucocorticoids) as first-line treatment as soon as possible, ideally within 3 months of the onset of persistent symptoms

- People with RA should have access to specialist physiotherapy, with periodic review to: improve general fitness and encourage regular exercise; learn exercises for enhancing joint flexibility, muscle strength and managing other functional impairments; learn about the short-term pain relief provided by methods such as transcutaneous electrical nerve stimulators [TENS]

- People with RA should have access to a multidisciplinary team (MDT); this should provide the opportunity for periodic assessments of the effect of the disease on their lives (such as pain, fatigue, everyday activities, mobility, ability to work or take part in social or leisure activities, quality of life, mood, impact on sexual relationships) and access to a named member of the MDT (for example, the specialist nurse) who is responsible for coordinating their care.

Dr Fergus Macbeth, NICE Guidelines Director said: “Rheumatoid arthritis can be a debilitating condition causing severe pain and limiting the ability to do everyday tasks. RA can have a significant impact not only on the 400,000 people in the UK with the disease, but also their families and carers, the NHS, and society in general, including the economic effects of early mortality and lost productivity. This new guideline incorporates a suite of previous NICE technology appraisals on drug treatment, so these together with the new guideline recommendations will enable health professionals to provide the best care for adults with RA to help reduce the impact of the condition on patients’ everyday lives.”

Dr Michael Rudolf, Chair of the Guideline Development Group, said: “This new guideline will help make sure that everyone with rheumatoid arthritis benefits from a consistent national approach to managing the condition. The need to carefully monitor the condition to reduce chance of disease progression is just one of the recommendations highlighted. This guideline sets standards for the best ways to support and treat patients with RA, thus helping to end the existing variation in practice and improving standards of care.”

Dr Chris Deighton, Clinical Advisor to the Guideline Development Group and Consultant Rheumatologist, said: “The good news is that early identification of rheumatoid arthritis and appropriate management or treatment can slow down the progression of the disease. Early diagnosis and referral to a specialist are key recommendations in this guideline – this will help us catch the disease at earlier stage where it may be possible to reduce future damage to the joints with disease-modifying drugs. The guideline also recommends physiotherapy, occupational therapy and interventions like relaxation and cognitive coping skills to help people with RA adjust to living with their condition.”

Mrs Ailsa Bosworth, Chief Executive of the National Rheumatoid Arthritis Society, and Patient and Carer Representative on the Guideline says: “Rheumatoid arthritis can have a huge impact on people’s lives, so this NICE guideline, if widely implemented, will help patients get the care they need. The guideline is clear that all patients should receive information on RA and discuss options with their doctors and nurses to find a treatment plan that suits them as an individual. This guideline will help patients understand what constitutes best practice in managing RA, and realise that putting up with unbearable pain doesn’t have to be an option. ”

Dr Louise Warburton, General Practitioner (specialist in RA) and Guideline Developer said: “It can be difficult to distinguish early rheumatoid arthritis symptoms from other conditions, but this guideline will help GPs to diagnose the condition early on. The guideline sets out a clear care pathway, and reminds health professionals to also discuss the wider impacts of the disease on the individual’s lifestyle, all of which will benefit patients enormously.”

About the guideline

1. The guidance is available at:

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