Review decision date: March 2015
We checked this guideline and decided that it should be updated. For details, see the update decision and theprocess for deciding if an update is needed. Details of the update will be available on the guidelines in development webpage in due course. No further checks of this guideline will be scheduled until this update is published.
Next review date: TBC
This guidance updates and replaces NICE technology appraisal 27 (published in July 2001) and NICE technology appraisal 72 (published in November 2003).
Rheumatoid arthritis is a long-term disease in which joints in the body become inflamed, causing pain, swelling and stiffness. It is known as an 'autoimmune disease' because it is caused when the body's immune system, which normally fights infection, starts to attack healthy joints. At times, rheumatoid arthritis can be very painful and affect a person's ability to carry out everyday tasks. It is not known why rheumatoid arthritis develops, and there is no cure. However, understanding of the disease has improved, and there are now effective treatments that can help ease the pain and symptoms, and slow down the disease. It is very important that treatment is started early to minimise damage to joints.
The advice in the NICE guideline covers the care of adults with rheumatoid arthritis. It does not specifically look at other types of arthritis such as osteoarthritis. NICE has also produced guidance on osteoarthritis, NICE guideline CG59 (published in February 2008).
Responsibility for undertaking a review of this guidance at the designated review date has passed to the National Clinical Guidelines Centre for Acute and Chronic Conditions (NCGC-ACC) The National Collaborating Centre for Chronic Conditions is no longer active
A correction has been made to the guideline. Recommendation 18.104.22.168 has been amended to remove text that stated an incorrect dose of etoricoxib for rheumatoid arthritis patients. The recommendation now reads: When offering treatment with an oral NSAID/COX-2 inhibitor, the first choice should be either a standard NSAID or a COX-2 inhibitor. In either case, these should be co-prescribed with a proton pump inhibitor (PPI), choosing the one with the lowest acquisition cost.
Note that recommendations 22.214.171.124 - 126.96.36.199 are adapted from osteoarthritis (CG59). These recommendations form part of the rheumatoid arthritis clinical guideline update of the rheumatoid arthritis aspects of osteoarthritis and rheumatoid arthritis - cox II inhibitors (TA27)
In August 2010, NICE published rheumatoid arthritis - drugs for treatment after failure of a TNF inhibitor (TA195). This replaces rheumatoid arthritis (refractory) - rituximab (TA126) and rheumatoid arthritis (refractory) - abatacept (TA141), which are referred to in section 2 of the NICE guideline on rheumatoid arthritis (CG79). Please see rheumatoid arthritis - drugs for treatment after failure of a TNF inhibitor (TA195) for the updated recommendations.
A clarification has been made to recommendation 188.8.131.52 about urgent referral for people with suspected persistent synovitis of undetermined cause.