Introduction and overview

Introduction and overview

Introduction

Rheumatoid arthritis is an inflammatory disease that typically affects the small joints of the hands and feet (but any joint can be affected). It is a systemic disease, which means that it does not just affect the musculoskeletal system but can affect the whole body, including the cardiovascular system, lungs, heart, eyes and small blood vessels (vasculitis). Medical management with drug therapy aims to relieve symptoms, modify the progress of the disease and the functional impairment associated with it, and reduce the risk of potential comorbidities.

There are approximately 350,000 people aged 16 years or older with rheumatoid arthritis in England alone, suggesting there may be as many as 422,000 people affected in the whole of the UK. Around 2.5 men and 5.4 women per 10,000 people develop rheumatoid arthritis per year, which translates into approximately 17,500 people developing the condition per year in England, and about 21,000 across the UK. The overall occurrence of rheumatoid arthritis is 2 to 4 times greater in women than men. Onset generally occurs between the ages of 40 and 60 years, but people of all ages can develop the disease.

Rheumatoid arthritis can result in a wide range of complications, and has a significant personal impact for people with the disease and their families and carers. It also has an economic impact on the NHS and society in general. Approximately one-third of people with rheumatoid arthritis stop work because of the disease within 2 years of onset, and this prevalence increases thereafter. The total costs of rheumatoid arthritis in the UK, including indirect costs and work-related disability, have been estimated at around £2.4 billion per year.

This quality standard covers the diagnosis and management of rheumatoid arthritis in adults (16 years and older). For more information see the scope for this quality standard.

NICE quality standards describe high-priority areas for quality improvement in a defined care or service area. Each standard consists of a prioritised set of specific, concise and measurable statements. They draw on existing guidance, which provides an underpinning, comprehensive set of recommendations, and are designed to support the measurement of improvement. The quality standard, in conjunction with the guidance on which it is based, should contribute to the improvements outlined in the following frameworks:

The table below shows the outcomes, overarching indicators and improvement areas from the frameworks that the quality standard could contribute to achieving:

The adult social care outcomes framework 2013-14

Domain 1: Enhancing quality of life for people with care and support needs

1A Social care related quality of life

People manage their own support as much as they wish, so that are in control of what, how and when support is delivered to match their needs

1B Proportion of people who use services who have control over their daily life

NHS outcomes framework 2013-14

Domain 2: Enhancing quality of life for people with long-term conditions

2 Health related quality of life for people with long term conditions

Ensuring people feel supported to manage their condition

2.1 Proportion of people feeling supported to manage their condition

Improving functional ability in people with long-term conditions

2.2 Employment of people with long-term conditions

Domain 4: Ensuring that people have a positive experience of care

4a Patient experience of primary care

4ai GP services

Improving people's experience of outpatient care

4.1 Patient experience of outpatient services

Public health outcomes framework 2013-16

Domain 1: Improving the wider determinants of health

Improvements against wider factors that affect health and wellbeing and health inequalities

1.8 Employment for those with a long-term health condition including those with a learning difficulty/disability or mental illness 

Overview

The quality standard for rheumatoid arthritis states that services should be commissioned from and coordinated across all relevant agencies encompassing the rheumatoid arthritis care pathway. A person-centred approach to provision of services is fundamental to delivering high-quality care to adults with rheumatoid arthritis.

The Health and Social Care Act 2012 sets out a clear expectation that the care system should consider NICE quality standards in planning and delivering services, as part of a general duty to secure continuous improvement in quality. Commissioners and providers of health and social care should cross refer across the library of NICE quality standards when designing high-quality services.

Patients, service users and carers may use the quality standard to find out about the quality of care they should expect to receive; support asking questions about the care they receive; and to make a choice between providers of health and social care services.

The quality standard should be read in the context of national and local guidelines on training and competencies. All healthcare professionals involved in assessing, caring for and treating people with rheumatoid arthritis should have sufficient and appropriate training and competencies to deliver the actions and interventions described in the quality standard.