The guideline focuses on four core areas of patient management:
- Referral for specialist management – refer any patient with suspected persistent synovitis of undetermined cause. Refer urgently if: the small joints of the hands or feet are affected; more than one joint is affected; or if there has been a delay of three months or more between onset of symptoms and seeking medical advice.
- Disease-modifying and biological drugs – a combination of DMARDs should be offered as soon as possible (ideally within three months) after onset of persistent symptoms. Where a combination of DMARDs is not appropriate, start monotherapy focusing more on fast escalation to a clinically effective dose than on choice of drug. Once the disease is controlled reduce doses to the lowest effective level.
- Monitoring disease – in recent-onset active disease, measure C-reactive protein and key components of disease activity monthly until treatment has controlled the disease to a level previously agreed with the patient.
- The multidisciplinary team – all patients should have access to a named member of the multidisciplinary team who is responsible for co-ordinating their care.
To view the full guideline visit the NICE website.