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Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

February NICE Guidance

The National Institute of Health and Clinical Excellence has published new guidance for the month of February.

There is one guideline that may impact on primary care, a clinical guideline on rheumatoid arthritis. 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.

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