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.