Abstract & Introduction
The management of rheumatoid arthritis (RA) requires early diagnosis and prompt initiation of therapy, together with lifestyle interventions, particularly smoking cessation. These guidelines recommend a treat-to-target strategy using a composite disease activity score at each visit, with frequent follow-up and escalation or switching of disease-modifying antirheumatic drug (DMARD) therapy until t
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The management of rheumatoid arthritis (RA) requires early diagnosis and prompt initiation of therapy, together with lifestyle interventions, particularly smoking cessation. These guidelines recommend a treat-to-target strategy using a composite disease activity score at each visit, with frequent follow-up and escalation or switching of disease-modifying antirheumatic drug (DMARD) therapy until the goal of low disease activity is achieved. A stepwise algorithm for DMARD therapy is provided. Screening for comorbidities and vaccination is advised. |
Rheumatoid arthritis (RA) is a chronic incurable disease that interferes with physical function, work productivity, and health-related quality of life (HRQoL). Despite improvements in therapies over the past three decades, a third of RA patients report work disability within 5 years of RA diagnosis, and mental and physical HRQoL scores among RA patients are worse than those of patients with other chronic illnesses such as cardiovascular disease and diabetes.[1] Active disease can lead to irreversible joint damage, which is frequently associated with permanent functional disability, emphasising the importance of early aggressive therapy to control disease activity.[2,3] Monitoring and modification of therapy, including multiple successive therapies, may be required; up to 60% of patients will not meet treatment goals after their first disease-modifying antirheumatic drug (DMARD), and >60% of these will require at least a third DMARD course.[4] With optimal treatment strategies, remission or low disease activity (LDA) can be achieved in up to 80% of patients.[3] In poorly resourced areas, outcomes tend to be worse.[5]
Tarr, G., Govind, N., Seboka, M., Gardiner, E., & Hodkinson, B. (2024). South African Rheumatism and Arthritis Association 2024 updated guidelines for the management of rheumatoid arthritis. South African Medical Journal, 114(9), e2598.