Rheumatoid arthritis

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Rheumatoid arthritis - Case studies

Last updated March 2010

Changes/additions to materials: (reviewed 9/9/10):

New NICE guidance

Since these materials were published, NICE has issued guidance on the following:

Rheumatoid arthritis - drugs for treatment after failure of a TNF inhibitor (adalimumab▼, etanercept▼, infliximab, rituximab and abatacept▼). This technology appraisal (TA195) replaces several previous NICE technology appraisals (TA141, TA126 and TA36).
Tocilizumab▼ for rheumatoid arthritis (TA198).
Etanercept▼, infliximab and adalimumab▼ for the treatment of psoriatic arthritis. This technology appraisal (TA199) replaces TA125 and TA104.

NICE has published guidance (TA186) recommending certolizumab pegol▼ as an option for the treatment of adults with rheumatoid arthritis (RA) only if:

• the drug is used in the same way as defined in the NICE TA130 for adalimumab▼, etanercept▼ and infliximab, and
• the manufacturer provides the first 12 weeks of certolizumab pegol▼ free of charge to all patients starting treatment.

More information is contained in the On the Horizon Stop Press No. 1135.

Case study 1: Elizabeth - a 62 year old lady with recent onset disease

This fictional case study discusses Elizabeth, a 62 year old lady with symptoms of persistent synovitis and asks you to play the part of a GP. Working through this case study will help you to:

  • Review your practice relating to identification and referral of people with possible rheumatoid arthritis (RA)
  • Evaluate the pros and cons of early intervention with DMARDs in RA
  • Evaluate the pros and cons of treatments for initial symptomatic management of RA.

Case study 2: Sarah, a 64 year old with established RA considering using a biological agent

This fictional case study discusses Sarah, a 64 year old lady with established rheumatoid arthritis (RA) and asks you to play the part of her GP. Working through this case study will help you to:

  • Review your practice relating management of people with established RA
  • Evaluate the pros and cons of corticosteroids in RA
  • Evaluate the pros and cons of biological drugs for management of RA.