Early RA management

Rheumatoid arthritis (RA) has various joint, tendon and other features, treatment is tailored to the different clinical manifestations. Early management is key for the effective treatment of RA. Synovitis causes symptoms, loss of function and loss of self-efficacy. Long-term outcomes may improve (e.g. reduced joint replacements) as a result of treating patients within the first 3 months.

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Symptom control
This involves using analgesics or NSAIDs for pain relief and reduce stiffness and swelling. DMARDs help control symptoms. The symptom control measures also includes the use of appropriate joint rest, maintain muscle function and physical supports.

This empowers patients and makes more efficient use of the primary and secondary care services in place to support them. Educational programmes have a place in the treatment.

Physical functioning
Physiotherapy and occupational therapy should be used early to maintain or improve physical functioning and especially mobility. Most efforts should be directed at activities of daily living with particular attention to help in the workplace or for significant leisure activities. Therapy complements and enhances the contribution of drug treatment.

Psychosocial functioning
Psychological and social support are important aspects of assessment and management of RA. The multidisciplinary team play essential roles in providing support for pain management, guidance on coping with the disease and encourages positive attitudes towards self-management and adjustment to the diagnosis of RA. Individuals should have social and psychological support to enable them to stay at work and participate in normal activities of daily living. Organisations such as NRAS and AC can assist with this.

Use of DMARD requires regular monitoring for drug toxicity.

Annual assessment of potential complications of disease should also encompass the longer-term screening programmes for osteoporosis, evidence of joint failure, atherosclerosis and hyperlipidaemia. Some of these might be best carried out in primary care after the first two years.

Ref: Luqmani et al, Rheumatology 2006

There is increasing evidence of the value of early treatment eg: http://www.excellence-in-rheumatology.org/content/early-management-rheumatoid-arthritisprof-paul-peter-tak-interviewed-prof-piet-van-rie