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Rheumatoid arthritis - Management
Basis for recommendation
This recommendation is based on the National Institute for Health and Clinical Excellence (NICE) guideline Rheumatoid arthritis: national clinical guideline for management and treatment in adults [National Collaborating Centre for Chronic Conditions, 2009; NICE, 2009].
Disease-modifying anti-rheumatic drugs (DMARDs)
- After reviewing the evidence (one meta-analysis, six randomized controlled trials, and three cohort studies), NICE concluded that for symptoms, quality of life, ability to achieve remission, and slowing of joint damage, combination therapies appear to be superior to monotherapy. There is no difference in tolerability between monotherapy and combination therapies.
- NICE stated that a combination DMARD regimen, compared with monotherapy, is more cost-effective in the management of rheumatoid arthritis.
Corticosteroids
- After reviewing the evidence, NICE concluded that the most successful and cost-effective combination therapy regimens all used corticosteroids in one form or another. Therefore, the use of corticosteroids is recommended when starting combination DMARD treatment.
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