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.