This site is intended for UK healthcare professionals, Guidelines Live 2020—now available on demand, depression in adults with a chronic physical health problem, Non-alcoholic steatohepatitis: identification, management, and referral pathways, New COVID guidelines focus on long-term effects and vitamin D. Refer for specialist opinion any adult with suspected persistent synovitis of undetermined cause. The content on this page is intended for UK healthcare professionals only. Recommendations for identifying and managing ‘long-COVID’ in primary care, Commissioned by Intercept Pharma UK and Ireland Ltd. Refer urgently (even with a normal acute-phase response, negative anti-cyclic citrullinated peptide [CCP] antibodies or rheumatoid factor) if any of the following apply: the small joints of the hands or feet are affected, there has been a delay of 3 months or longer between onset of symptoms and seeking medical advice, If the following investigations are ordered in primary care, they should not delay referral for specialist opinion, Offer to carry out a blood test for rheumatoid factor in adults with suspected rheumatoid arthritis (RA) who are found to have synovitis on clinical examination, Consider measuring anti-CCP antibodies in adults with suspected RA if they are negative for rheumatoid factor, X-ray the hands and feet in adults with suspected RA and persistent synovitis. This guidance has been updated and replaced by NICE guideline NG100. Definitions of remission or low disease activity vary according to the measure used. If an adult with RA develops any symptoms or signs that suggest cervical myelopathy: Do not let concerns about the long-term durability of prosthetic joints influence decisions to offer joint replacements to younger adults with RA. NICE accepts no responsibility for the use of its content in this product/publication. Refer urgently (even with a normal acute-phase response, negative anti-cyclic citrullinated peptide [CCP] antibodies or rheumatoid factor) if any of the following apply: 1.1. the small joints of the hands or feet a… This guideline was developed by a multidisciplinary expert panel: Cooper C et al with the support of an educational grant from UCB Pharma Ltd. Management of RA depends on a multidisciplinary approach and shared care between secondary and primary care. Welcome to Guidelines. This will require revision of local protocols in order that step-up protocols may be implemented rather than initial combination therapy. Offer to refer adults with RA for an early specialist surgical opinion if any of the following do not respond to optimal non-surgical management: persistent pain due to joint damage or other identifiable soft tissue cause. RA typically presents as inflammatory arthritis affecting the small joints of the hands and the feet (usually both sides equally and symmetrically) although any synovial joint can be involved. For example, with the DAS28, remission is a score of <2.6 and low disease activity is ≤3.2. Add filter for National Rheumatoid Arthritis Society - NRAS (35) ... Everything NICE has said on managing rheumatoid arthritis in adults in an interactive flowchart. The availability of specialist nurses is often instrumental in supporting these recommendations and service planning should consider the resources required to deliver both monthly monitoring and annual review. Evidence-based information on rheumatoid arthritis guidelines from hundreds of trustworthy sources for health and social care. The guideline recommends referral in any patient when: Referral should be guided by clinical examination and should not be delayed by waiting for results of any investigations as they may be normal especially in early disease. NICE does not recommend a preference for first line therapy [ NICE, 2018a ], however the ACR suggests that methotrexate should be the preferred initial treatment for most people with rheumatoid arthritis [ ACR, 2015 ], and EULAR recommends that methotrexate should be part of the first treatment strategy for people at risk of persistent disease, unless contraindicated [ Combe, 2016 ]. This summary of the NICE rheumatoid arthritis guideline covers: View this summary online at guidelines.co.uk/454370.article, Algorithm 1: Rheumatoid arthritis—referral, diagnosis and investigations, NICE has published a guideline on depression in adults with a chronic physical health problem, Algorithm 2: Rheumatoid arthritis management and monitoring. Diagnosis and management of rheumatoid arthritis in adults: summary of updated NICE guidance BMJ. The UK’s National Institute for Health and Care Excellence (NICE) has recommended AbbVie’s Rinvoq (upadacitinib) for people with previously treated severe active rheumatoid arthritis (RA). People should also have rapid access to specialist care if their condition suddenly worsens. Ultrasound scanning of joints is increasing, and the recommendation not to use ultrasound routinely may need to be reflected in the revision of local protocols. Refer for specialist opinion any adult with suspected persistent synovitis of undetermined cause. What are the implications of these guidelines for commissioners and providers of services for people with RA? Lage-Hansen PR et al. If anti-CCP antibodies are present or there are erosions on X-ray: advise the person that they have an increased risk of radiological progression but not necessarily an increased risk of poor function, emphasise the importance of monitoring their condition, and seeking rapid access to specialist care if disease worsens or they have a flare, see Algorithm 1 for referral, diagnosis, and investigations, Treat active RA in adults with the aim of achieving a target of remission or low disease activity if remission cannot be achieved (treat-to-target). Services is important to achieve treatment targets, see recommendation 1.2.1 National guideline Centre, College. Suddenly worsens secondary care when explaining risk factors for progression to some patients require additional analgesia in diagnosing rheumatoid on. 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