Rheumatoid arthritis: national clinical guideline for management and treatment in adults

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Developed by the National Collaborating Centre for Chronic Conditions, published in February 2009

Rheumatoid arthritis (RA) is a chronic, progressive autoimmune disease, affecting over 400,000 people in the UK. In most people with RA, the disease is characterised by synovitis of the peripheral joints, resulting in swelling, stiffness, pain, joint destruction and functional disability. The guideline covers the management of people with RA all the way through the disease process - from early identification to severe disease.

Increasing evidence has supported the need for early recognition of RA, aggressive drug intervention for active disease, and close monitoring of disease control. The management of RA is not limited to pharmacological treatment, but is multi-faceted, involving interventions given by various members of a multidisciplinary team. Annual review and ongoing access to the multidisciplinary team should be made available to deal with the impact of RA on the musculoskeletal system and other organ systems, to ensure that medication is appropriate, and, just as importantly, to address the psychological and social consequences of the disease. Each person with RA needs to be equipped with the knowledge, skills and resources to be able to minimise the effects of the disease.

As well as providing a comprehensive guide to the management of RA for GPs and specialists, the guideline will also be relevant to nurses, physiotherapists, occupational therapists, podiatrists, orthopaedic surgeons, commissioners, primary care trusts, and strategic health authorities.

This guideline, which is available to purchase or download as a pdf, provides a single useful and accessible reference for promoting a consistent high quality of care and improved quality of life for people with RA.


  • The development
  • Introduction
  • Methodology
  • Key messages of the guideline
  • The guideline
  • Referral, diagnosis and investigations
  • Communication and education
  • The multidisciplinary team
  • Pharmacological management
  • Monitoring rheumatoid arthritis
  • Other aspects and treatment
  • NICE technology appraisal related recommendations
  • Areas for future research

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