NICE updates guidance for managing RA

NICE has set out updated advice on managing RA, with new recommendations on treatment, the aim of treatment, symptom control and monitoring.

Rheumatoid arthritis (Photo: iStock)
Rheumatoid arthritis (Photo: iStock)

NICE has published new draft guidance on the management of RA in adults this week. Originally launched in 2009, the guidance was last reviewed by NICE in 2015. The current draft will be open for consultation until 1 March this year.

In a change from NICE’s earlier recommendations, it advocates starting treatment with just one cDMARD drug instead of a combination of cDMARDs. Further cDMARDs should be added if treatment targets are not met despite dose escalation.

The aim of treatment should be remission or ‘low disease activity’ if remission cannot be achieved, it says.


It also newly recommends prescribing NSAIDs to help control symptoms of pain or stiffness if required.

Patients should be given review appointments every six months after achieving treatment targets. If the treatment target is maintained for at least one year without glucocorticoids, it advises doctors to consider reducing or withdrawing drugs in a step-down strategy.

NICE said: ‘We have reviewed the evidence and updated or added new recommendations on investigations following diagnosis, treat-to-target strategy, initial pharmacological management, symptom control and monitoring.’

Around 1.5 men and 3.6 women per 10,000 people develop RA each year, with the disease most likely to occur when patients are in their 70s.

Swedish research published last year found that taking the oral contraceptive pill for seven years or more continuously was linked to a 19% reduced risk of RA.

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