Peer Reviewed
Feature Article Arthritis
Rheumatoid arthritis – early management guidelines for GPs
Abstract
Rheumatoid arthritis is the commonest systemic autoimmune disease, affecting 1% of the population, with a high cardiovascular mortality and significant economic impact and morbidity. Aggressive treatment within the initial six months to two years of disease onset is needed to improve long term outcome.
Key Points
- Being familiar with the American College of Rheumatology classification criteria for rheumatoid arthritis and excluding common differential diagnoses (including viral arthropathies) will enable you to recognise rheumatoid arthritis among symmetrical inflammatory polyarthropathies of at least six weeks’ duration.
- Early liaison with a rheumatologist may confirm the diagnosis and allow initiation of therapy. Ideally, disease modifying drugs should be started within three months of onset of disease, because joint damage occurs quickly. Biological agents targeting tumour necrosis factor, namely etanercept and infliximab, look promising but are currently reserved for patients who have failed first line therapies.
- Intra-articular injection of corticosteroid is a useful option for acutely inflamed joints. High dose systemic corticosteroids should not be used, except in specific situations such as vasculitis or interstitial lung disease.
- Patient education, monitoring for articular and extra-articular complications and toxicities of drugs, physiotherapy and occupational therapy are other cornerstones of the early management of rheumatoid arthritis.
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