Management

Goals of RA management are: (1,2,3)

• minimizing joint pain and swelling
• preventing deformity (such as ulnar deviation) and radiographic damage (such as erosions)
• maintaining quality of life (personal and work)
• controlling extra-articular manifestations.

Treat-to-target strategy

• 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)
• consider making the target remission rather than low disease activity for people with an increased risk of radiological progression (presence of anti-CCP antibodies or erosions on X-ray at baseline assessment)
• in adults with active RA, measure C-reactive protein (CRP) and disease activity (using a composite score such as DAS28) monthly in specialist care until the target of remission or low disease activity is achieved.

People with rheumatoid arthritis should have ongoing access to a multidisciplinary team. This should provide the opportunity for periodic assessments of the effect of the disease on their lives (such as pain, fatigue, everyday activities, mobility, ability to work or take part in social or leisure activities, quality of life, mood, impact on sexual relationships) and help to manage the condition

Furthermore patients should have access to a named member of the multidisciplinary team (for example, the specialist nurse) who is responsible for coordinating their care.

Management of RA include:

• medical
• non-pharmacological
• surgical management
• practical problems in rheumatoid arthritis

Reference:

1. Fraenkel L, Bathon JM, England BR, et al. 2021 American College of Rheumatology guideline for the treatment of rheumatoid arthritis. Arthritis Rheumatol. 2021 Jul;73(7):1108-23.
2. NICE. Rheumatoid arthritis in adults: management. NICE guideline NG100. Published July 2018, last updated October 2020.
3. Smolen JS et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2022 update. Ann Rheum Dis. 2023 Jan;82(1):3-18 Epub 2022 Nov 10.