GUIDELINES - BSR and BHPR guidelines for the management of RA after the first 2 years

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Rheumatology Advance Access published online on January 27, 2009

Rheumatology, doi:10.1093/rheumatology/ken450a

British Society for Rheumatology and British Health Professionals in

Rheumatology guideline for the management of rheumatoid arthritis

(after the first 2 years)

Raashid Luqmani1, Sheena Hennell2, Cristina Estrach3, Damian Basher4,

Fraser Birrell5,6,7, Ailsa Bosworth8, Burke9, Carole

Callaghan10, Candal-Couto11, Fokke12, Nicola Goodson3,

Dawn Homer13, Jackman14, a Jeffreson15, Oliver16, Mike

11, Sanz17, Zoe Stableford18, 19, Nick Todd20,

Louise Warburton21, Washbrook12, Mark Wilkinson22 on behalf of

the British Society for Rheumatology and British Health Professionals

in Rheumatology Standards, Guidelines and Audit Working Group

1Nuffield Orthopaedic Centre and University of Oxford, Oxford, 2Wirral

Hospital NHS Trust, Wirral, 3Aintree University Hospital, Aintree,

4Wessex Public Health, Hampshire, 5Department of Rheumatology,

Wansbeck General Hospital, Wansbeck, 6Department of Rheumatology,

Freeman Hospital, 7Newcastle University, Newcastle, 8National

Rheumatoid Arthritis Society, Maidenhead, 9Pulvertaft Hand Centre,

Derby, 10Pharmacy Department, Western General Hospital, Edinburgh,

11Wansbeck General Hospital, Wansbeck, 12Royal National Hospital for

Rheumatic Diseases, Bath, 13Department of Rheumatology, University

Hospital Birmingham NHS Foundation Trust, Birmingham, 14Langford

Medical Practice, Bicester, 15 and Agnes Hunt Orthopaedic

and District Hospital NHS Trust, Oswestry, 16Royal College of Nursing

Rheumatology Forum and Litchdon Health Centre, Barnstaple,

17Department of Orthopaedics, Macclesfield District General Hospital,

Macclesfield, 18Department of Podiatry, Hope Hospital, Salford,

19Kennedy Institute of Rheumatology, London, 20Newcastle General

Hospital, Newcastle, 21Telford and Wrekin Primary Care Trust, Telford

and 22Stockport NHS Foundation Trust, Stockport, UK.

Scope and purpose of the guideline

RA in its severe form is a considerable health burden [1]. Patients

with established RA, which has an annual estimated incidence of

30–54/100 000 in women and 13–25/100 000 in men [2], require effective

coordination of health and social services to support them at work, or

at home through the variable course of their illness. The current

guideline follows directly from the first guideline on early

management of RA [3]. It deals with the long-term management of RA in

primary and secondary care to provide seamless support for patients. A

strong emphasis is made on enabling patients to self-manage some

aspects of their condition and make informed treatment choices.

These guidelines inform service delivery on evidence-based care and

can provide an important framework in the development of Integrated

Care Pathways to enable RA, to be managed effectively in all care

settings.

We propose a model of care for patients including the use of DMARDs or

biologic agents, ongoing education and specialist management, with

increasing emphasis on shared care between patients, primary care and

secondary care [4].

The goals of therapy supported by this guidance are to: (i) control

synovitis; (ii) control symptoms; (iii) promote self-management; (iv)

improve physical functioning; (v) improve psycho-social functioning;

(vi) monitor for drug toxicity; and (vii) manage and screen for

comorbidity.

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Read the full article here:

http://rheumatology.oxfordjournals.org/cgi/content/full/ken450av1

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