Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune disease. It is characterised by symmetrical joint involvement and extra-articular manifestations. Joint and periarticular tissue destruction occurs as a result of inflammation of the synovial joints, leading to functional impairment. Early diagnosis and treatment are the key to minimising the significant daily challenges experienced by patients and underpin more successful outcomes. This article will explore the recognition and management of RA in primary care, drawing on recently updated National Institute for Health and Care Excellence guidelines.
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References
1.
AndersonJCaplanLYazdanyJ, et al.(2012) Rheumatoid arthritis disease activity measures: American College of Rheumatology recommendations for use in clinical practice. Arthritis Care and Research64(5): 640–647. DOI: 10.1002/acr.21649.
2.
Avina-ZubietaJAChoiHKSadatsafaviM, et al.(2008) Risk of cardiovascular mortality in patients with rheumatoid arthritis: A meta-analysis of observational studies. Arthritis and Rheumatology59(12): 1690–1697. DOI: 10.1002/art.24092.
3.
Benjamin O and Lappin SL (2019) Disease modifying anti-rheumatic drugs (DMARD). StatPearls. Available at: www.ncbi.nlm.nih.gov/books/NBK507863/ (accessed 16 June 2019).
4.
BriggsAMFaryRESlaterH, et al.(2013) Physiotherapy co-management of rheumatoid arthritis: Identification of red flags, significance to clinical practice and management pathways. Manual Therapy18(6): 615–619. DOI: 10.1016/j.math.2013.01.006.
5.
BruceBFriesJ (2003) The Stanford health assessment questionnaire: Dimensions and practical applications. Health and Quality of Life Outcomes1: 20. DOI: 10.1186/1477-7525-1-20.
JethwaHAbrahamS (2018) Biologic agents in inflammatory arthritis. British Journal of General Practice68(669): 204–205. DOI: 10.3399/bjgp18X695705.
10.
LedinghamJGullickNIrvingK, et al.(2017) BSR and BHPR guideline for the prescription and monitoring of non-biologic disease-modifying anti-rheumatic drugs. Rheumatology56(6): 865–868DOI: 10.1093/rheumatology/kew479.
11.
LittlejohnEAMonradSU (2018) Early diagnosis and treatment of rheumatoid arthritis. Primary Care: Clinics in Office Practice45(2): 237–255. DOI: 10.1016/j.pop.2018.02.010.
NICE (2018b) NICE guideline 100: Rheumatoid arthritis in adults: management. Available at: www.nice.org.uk/guidance/ng100 (accessed 30 May 2019).
17.
NICE (2018c) Clinical knowledge summary: DMARDs scenario: General principles of managing DMARDs. Available at: https://cks.nice.org.uk/dmards#!scenario (accessed 16 June 2019).
Scottish Intercollegiate Guidelines Network (2011) Management of early rheumatoid arthritis. Available at: www.sign.ac.uk/assets/sign123.pdf (accessed 1 June 2019).
26.
SmolenJSLandewéRBijlsmaJ, et al.(2017) EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2016 update. Annals of the Rheumatic Diseases76(6): 960–977. DOI: 10.1136/annrheumdis-2016-210715.
27.
StrandVKhannaD (2010) The impact of rheumatoid arthritis and treatment on patients' lives. Clinical and Experimental Rheumatology28(3 Suppl 59): 32–40. Available at: www.clinexprheumatol.org/article.asp?a=957 (accessed 30 May 2019).
XueAWuSJiangL, et al.(2017) Bone fracture risk in patients with rheumatoid arthritis: A meta-analysis. Medicine36(9): e6983DOI: 10.1097/MD.0000000000006983.
