Rheumatoid Arthritis in Adults: Management (NICE NG100)

NICE NG100 covers the management of rheumatoid arthritis including conventional DMARD therapy, biologic therapy, treat-to-target principles, and monitoring.

Key Recommendations

• Start conventional DMARD therapy (methotrexate) within 3 months of persistent synovitis
• Combine methotrexate with short-term bridging corticosteroids when starting DMARD
• Treat-to-target: aim for remission or low disease activity (DAS28 <2.6)
• Consider biologic DMARD (TNF inhibitor) after failure of ≥2 conventional DMARDs
• Monitor: FBC, U&E, LFTs, every 2-3 months on methotrexate; annual DEXA if on corticosteroids
• Annual cardiovascular risk assessment for all RA patients
• Refer urgently if large joint septic arthritis suspected (joint aspiration for culture)