Overview of management for rheumatoid arthritis

The primary goal of management for people with rheumatoid arthritis (RA) is to maximise long-term quality of life. To achieve this, management is individualised, and aims to:

• control disease activity; outcomes that are most important to patients include
  • pain relief
  • maintaining normal function (eg improvements in physical function, psychological health, sleep pattern and relationships)
  • participation in social and work-related activities
• prevent irreversible articular and extra-articular damage by early induction and maintenance of clinical remission with immunomodulatory drug therapy
• detect adverse drug reactions and complications of immunomodulatory drugs
• manage comorbidities associated with RA (eg cardiovascular disease).

People with RA require integrated, multidisciplinary care designed to manage their broad spectrum of needs in a timely manner. This is best achieved with a team of healthcare professionals, which usually includes the patient’s general practitioner, their specialist (usually a rheumatologist) and, depending on the situation, a physiotherapist, occupational therapist, podiatrist or psychologist.

All people require an individualised self-management plan, negotiated between the person and their multidisciplinary healthcare team. The individualised self-management plan should:

• include both nonpharmacological and pharmacological treatment plans
• encourage self-management by
  • addressing the person’s expectations
  • advising on management of symptom flares (ie increases in disease activity) prior to specialist review
  • supporting lifestyle choices that may improve the person’s prognosis (eg stopping tobacco smoking).