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NICE issues updated guidelines on managing rheumatoid arthritis

Posted: 19/09/2018


The National Institute for Health and Care Excellence (NICE) has issued new guidelines for diagnosing and managing rheumatoid arthritis in adults. 

In the UK, rheumatoid arthritis affects more than 400,000 people. It is a long-term condition that causes joint pain and swelling, and is usually associated with stiffness in the hands, wrists and feet. The symptoms can cause severe pain, making it hard for sufferers to go about their normal lives, and it can have a significant impact on their ability to work. There is no permanent cure, but early treatment can help to control it. 

The new guidelines aim to improve quality of life for people suffering with rheumatoid arthritis by ensuring they have the correct treatment to slow the progression of the condition and control their symptoms. They also aim to ensure that rapid access to specialist care is provided to sufferers if their condition suddenly worsens.

NICE’s guidance suggests that adults who are suffering from persistent soft tissue joint swelling of an undetermined cause should be referred for specialist opinion. This should happen urgently if the small joints of the hands or feet are affected; more than one joint is affected; or if there has been a delay of three months or more between the onset of symptoms and seeking medical advice. Once a diagnosis of rheumatoid arthritis has been established, functional ability should be measured to provide a baseline for assessing response to treatment.

The aim of treatment should be to achieve a target of remission or low disease activity (if remission cannot be achieved) by applying tight controls which could include monthly visits and treatment adjustment. 

The new guidelines put particular emphasis on the importance of monitoring the condition. NICE stipulates that there should be rapid access to specialist care where required, information about when and how to access this care, and that drug monitoring should be ongoing. A review appointment should also take place six months after reaching the treatment target to ensure that it has been maintained, and there should subsequently be an annual review for those who have achieved their treatment target.

All treatment options should be discussed fully with a patient. There are many medications available that can be used to help prevent rheumatoid arthritis getting worse and reduce the risk of further problems / deterioration. This medication is divided into two types: disease-modifying anti-rheumatic drugs (DMARDs) and biological treatments. However, in some cases, damage to the joints can occur and surgery may be required to help relieve symptoms and restore use of the joint. Examples of the types of surgery that are often performed in such circumstances include arthroscopy to remove inflamed tissue, and if the condition is severe, a hip or knee replacement may be necessary.

Penningtons Manches has experience of acting for clients who have raised concerns about the management of their arthritis – relating to delays in providing the appropriate care as well as negligent advice on their treatment options, and negligent surgery which, rather than alleviating their symptoms, has left them worse off than before their operation.

Naomi Holland, an associate in the clinical negligence team, comments: “The NICE guidelines are helpful in terms of reinforcing best practice on the management of rheumatoid arthritis in patients, which can be a very debilitating condition and will often have an impact on their quality of life. It is important that patients undergo prompt investigation to get an appropriate diagnosis, and once diagnosed, that a full discussion takes place about the treatment options available, together with the associated risks and benefits of each option. We frequently speak to clients who have not been appropriately informed of the various options available, which can result in, for example, unnecessary surgery when a conservative approach would have been a reasonable alternative. In other cases, clients have undergone surgery but have experienced complications with nerve injuries or damage to surrounding tissue and structures.

“If you, a friend or family member have concerns about the management or treatment of rheumatoid arthritis – or indeed the management of any other orthopaedic related condition, please contact our specialist orthopaedic team on freephone 0800 328 9545.”


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