NICE RA guidelines Feb 2009

NEW NICE GUIDELINE: NRAS URGE ‘SWIFT AND WIDESPREAD’ IMPLEMENTATION TO IMPROVE TREATMENT OF RHEUMATOID ARTHRITIS

The National Rheumatoid Arthritis Society (NRAS) welcomed the new NICE guideline on rheumatoid arthritis (RA) on 23rd February 2009 and called for its ‘swift and widespread’ implementation.

The National Institute for Health and Clinical Excellence (NICE) published a new guideline in February 2009 setting out advice to practitioners and patients on the best models of treatment for RA from diagnosis through to treatment and ongoing specialist care.

RA is a chronic, progressive, disabling condition affecting almost half a million people of all ages in the UK, with 12,000 new patients diagnosed each year. RA is an autoimmune disease caused when the body’s own immune system starts to attack healthy joints , most commonly the hands, feet and wrists. When untreated, RA can progress rapidly, causing swelling and damage to cartilage and bone around the joints and severe amounts of pain.

NRAS are calling for this guideline to be implemented swiftly to enable all RA patients to access the best standards of care available. There is no cure for the disease but early access to a range of treatments can slow down the progression of RA and long-term specialist care and support can enable patients to manage their condition effectively.

Welcoming the guideline, Ailsa Bosworth , Chief Executive of the NRAS, said:

“This NICE guideline will help patients get the care they need if its implementation is widespread. The guideline is clear that all patients should be tightly managed, particularly in the early stages of disease which should improve long term outcomes. This guideline will help patients understand what constitutes best practice in managing RA, and realise that putting up with uncontrolled symptoms doesn’t have to be an option.”

Key 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 three months of the onset of persistent symptoms.
• In all patients with early active disease, key constituent parts of disease activity and CRP should be measured monthly (using a composite score such as DAS28) until an agreed level of disease control has been achieved by appropriate treatment.
• 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.

The NICE Guideline on RA is available at www.nice.org.uk/CG79