The European League Against Rheumatism (EULAR) have published an update to their 2007 recommendations for the management of early arthritis. This committee strongly recommends early referral to a rheumatologist and early non pharmacologic interventions including smoking cessation, dental care, weight control, vaccination assessment, and comorbidity management. Patients should understand that these are a professional organization’s recommendations and don't necessarily reflect the latest advances in the management of rheumatoid and other inflammatory arthritis.
12 Key Recommendations
- Patients with arthritis (any joint swelling, associated with pain or stiffness) should seen by a rheumatologist, within 6 weeks after the onset of symptoms.
- Clinical examination is the method of choice for detecting arthritis, which may be confirmed by ultrasonography.
- If a definite diagnosis cannot be reached and the patient has early undifferentiated arthritis, risk factors for persistent and/or erosive disease, including number of swollen joints, acute phase reactants, rheumatoid factor, ACPA, and imaging findings, should be considered in management decisions.
- Patients at risk of persistent arthritis should be started on DMARDs as early as possible (ideally within 3 months), even if they do not meet classification criteria for an inflammatory rheumatologic disease.
- Methotrexate is considered to be the anchor drug and should be part of the first treatment strategy.
- NSAIDs are effective symptomatic therapies but should be used at the minimum effective dose for the shortest time possible.
- Steroids effectively reduce pain, swelling and structural progression, but should be used at the lowest dose necessary as treatment. Intra-articular steroid injections should be considered for the relief of local symptoms of inflammation.
- The main goal of DMARD treatment is to achieve clinical remission. Regular monitoring of disease activity and side effects should guide decisions on choice and changes in treatment strategies.
- Monitoring of disease activity should occur every 1 to 3 months and include tender and swollen joint counts, patient and physician global assessments, ESR and CRP, usually by applying a composite measure.
- Non-pharmacological interventions, such as dynamic exercises and occupational therapy, should be considered as adjuncts to drug treatment in patients with early arthritis.
- In patients with early arthritis smoking cessation, dental care, weight control, assessment of vaccination status and management of comorbidities should be part of overall patient care.
- Patient information concerning the disease, its outcome (including comorbidities) and its treatment is important. Education programs aimed at coping with pain, disability, maintenance of ability to work and social participation may be used as adjunct interventions.
Reference: Combe B, Landeve R, Kaien C, et al. 2016 update of the EULAR recommendations for the management of early arthritis. Ann Rheum Dis doi:10.1136/annrheumdis-2016-210602. Can be accessed http://ard.bmj.com/content/early/2016/12/15/annrheumdis-2016-210602.full