This guideline covers diagnosing and managing rheumatoid arthritis. It aims to improve quality of life by ensuring that people with rheumatoid arthritis have the right treatment to slow the progression of their condition and control their symptoms. People should also have rapid access to specialist care if their condition suddenly worsens.
NICE has produced a COVID-19 rapid guideline on rheumatological autoimmune, inflammatory and metabolic bone disorders. It recommends changes to usual practice to maximise the safety of patients and protect staff from infection during the COVID-19 pandemic.
NICE has also produced technology appraisal guidance on drug treatment for rheumatoid arthritis.
In October 2020, we amended the ‘treat to target’ recommendations to clarify that multiple disease-modifying anti-rheumatic drugs can be offered one after the other to achieve treatment targets.
This guideline includes new and updated recommendations on:
- investigations following diagnosis
- treat-to-target strategy and initial pharmacological management
- symptom control and monitoring
It also includes recommendations on:
- investigations for diagnosis and referral from primary care
- non-pharmacological management and the multidisciplinary team
- communication and education
- timing and referral for surgery
Who is it for?
- Healthcare professionals
- Commissioners and providers
- People with rheumatoid arthritis and their families and carers
Guideline development process
This guideline updates and replaces NICE guideline CG79 (February 2009).
The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian.
All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.
Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.