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Rheumatoid arthritis - Management
Basis for recommendation
These recommendations are based on the National Institute for Health and Clinical Excellence (NICE) guideline Rheumatoid arthritis: the management of rheumatoid arthritis [NICE, 2009].
- After reviewing four cross-sectional studies and one retrospective case series, NICE concluded that there was a lack of evidence to address the question of appropriate timing for surgery. However, NICE considered it appropriate to involve surgeons early, even if surgery was not urgently indicated, particularly where the outcome could be jeopardized by a delay in referral (for example, possible tendon rupture, localized non-responding synovitis).
- Indications for joint replacement in RA should be considered in the same way as for people with osteoarthritis. However, NICE stated that people with RA might be considerably younger and the wear and tear of the prosthetic joint could well be less (in view of the polyarthritic nature of RA). Therefore, people should be considered for a joint replacement regardless of their age.
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