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Rheumatoid arthritis - Management
How should I manage suspected rheumatoid arthritis?

  • Refer people with persistent synovitis with an unknown cause to a rheumatologist. Refer urgently (within 2 weeks), if there are any of the following:
    • Small joints of the hands or feet are affected.
    • More than one joint is affected.
    • There has been a delay of 3 months or longer between the onset of symptoms and the person seeking medical advice.
  • Do not delay referral if blood tests are normal or have not returned from the laboratory.
  • Offer paracetamol with or without codeine (prescribed separately) for pain relief. If pain is not controlled with paracetamol with or without codeine, prescribe:
    • A nonsteroidal anti-inflammatory drug (NSAID) such as ibuprofen, naproxen, or diclofenac plus a proton pump inhibitor (PPI), or
    • A coxib (such as celecoxib or etoricoxib) plus a PPI.
    • Advise the person to use the NSAID or coxib as required, and at the lowest effective dose for the shortest period time.
    • In people at risk of cardiovascular adverse events, ibuprofen up to 1200 mg per day or naproxen up to 1000 mg per day are recommended as first-line options.
    • For information on doses of NSAIDs, coxibs, and PPIs, see Prescriptions. For information on contraindications, cautions, and managing the adverse effects and interactions of NSAIDs and coxibs, see the CKS topic on NSAIDs - prescribing issues.
  • Do not prescribe a corticosteroid in primary care before a specialist assessment is carried out.

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