Guidance
Update information
October 2020: We amended recommendation 1.2.1 to clarify that multiple disease-modifying anti-rheumatic drugs can be offered one after the other to achieve treatment targets. We also added a cross-reference to the recommendation from section 1.5 and recommendation 1.9.3.
July 2018: We have reviewed the evidence and made new recommendations on investigations following diagnosis, treat-to-target strategy, initial pharmacological management, symptom control and monitoring. These recommendations are marked [2018].
We have also made some changes without an evidence review to:
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clarify when urgent referral is needed
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clarify when measuring anti-cyclic citrullinated peptide antibodies might be considered for diagnosis
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clarify that X-ray of the hands and feet applies to adults with suspected rheumatoid arthritis (RA)
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clarify that other treatments rather than analgesics should be considered for people on low-dose aspirin (analgesics other than NSAIDs are no longer recommended)
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clarify that all adults with RA should have an annual review, including those who have reached their treatment target.
These recommendations are marked [2009, amended 2018].
Recommendations marked [2009] or [2015] last had an evidence review in 2009 or 2015. In some cases minor changes have been made to the wording to bring the language and style up to date, without changing the meaning.
Minor changes since publication
January 2022: Minor changes to redirect NICE Pathways links.
July 2019: Cost analysis was changed to economic analysis in the rationale for DMARDs.