NICE has released NICE Guideline (NG) 100 on Rheumatoid arthritis in adults: management, which replaces Clinical Guideline 79. NICE has also updated Quality Standard 33 on Rheumatoid arthritis in over 16s to reflect the new recommendations.

Rheumatoid arthritis (RA) is an inflammatory disease, which affects 1.5 men and 3.6 women in every 10,000 people per year, possibly affecting as many as 422,000 people in the UK. While it is most common in people who are in their 70s, it can affect people of all ages.

Around one-third of people with RA stop working because of the disease within a few years of onset, which can cause indirect costs to the economy in lost productivity, in addition to the direct costs to the NHS and healthcare support services. It also has a substantial personal impact on the patient with RA and their families, particularly if complications develop.

The recommendations in NG100 are focused on the diagnosis and management of RA, offering new and updated advice on:

  • referral, diagnosis, and investigations
  • treat-to-target strategy
  • communication and education
  • initial pharmacological management
  • further pharmacological management
  • symptom control
  • the multidisciplinary team
  • non-pharmacological management
  • monitoring
  • timing and referral for surgery.

Updates were also made to clarify certain areas and to bring others up to date and in line with the latest evidence, including:

  • investigations following diagnosis
  • treat-to-target strategy
  • initial pharmacological management
  • symptom control and monitoring.

Quality Standard 33 has been updated to reflect the new recommendations made by NG100, including changes to quality statements on starting treatment and disease control.