Rheumatoid arthritis in over 16s

Structure

a) Evidence of local arrangements to start treatment with cDMARD monotherapy for adults with active rheumatoid arthritis within 6 weeks of referral from primary care.

Data source: Local data collection, for example, service protocols and treatment strategies.

b) Evidence of local arrangements to measure CRP and disease activity monthly in adults with active rheumatoid arthritis until they are in remission or have low disease activity if remission cannot be achieved.

Data source: Local data collection, for example, service protocols and treatment strategies.

Process

a) Proportion of adults with suspected persistent synovitis who have specialist assessment within 3 weeks of referral from primary care.

Numerator – the number in the denominator who have specialist assessment within 3 weeks of referral.

Denominator – the number of adults with suspected persistent synovitis referred to rheumatology services.

Data source: The National Early Inflammatory Arthritis Audit collects data on time from referral to specialist assessment.

b) Proportion of adults with active rheumatoid arthritis starting cDMARD monotherapy within 6 weeks of referral from primary care.

Numerator – the number in the denominator who start cDMARD monotherapy within 6 weeks of referral.

Denominator – the number of adults with active rheumatoid arthritis referred to rheumatology services.

Data source: Local data collection, for example, audit of electronic prescription records. The National Early Inflammatory Arthritis Audit collects data on time from referral to initiation of cDMARD therapy.

c) Proportion of adults with active rheumatoid arthritis who have their CRP and disease activity score measured monthly.

Numerator – the number in the denominator who had their CRP and disease activity score measured within the past month.

Denominator – the number of adults with active rheumatoid arthritis.

Data source: Local data collection, for example, audit of patient records.

Outcome

a) Disease activity for adults with rheumatoid arthritis.

Data source: The National Early Inflammatory Arthritis Audit collects data on mean disease activity score (DAS28) at baseline, 3-month and 12-month follow up.

b) Health-related quality of life for adults with rheumatoid arthritis.

Data source: The National Early Inflammatory Arthritis Audit collects data on patient-reported quality of life, including symptoms, wellbeing, impact on daily life and work, in the patient questionnaire at baseline, 3-month and 12-month follow up.

Treatment target

A treat-to-target strategy should be used for adults with rheumatoid arthritis. This defines a treatment target (such as remission or low disease activity if remission cannot be achieved) based on a composite score such as DAS28 and applies tight control (such as monthly monitoring with treatment adjustment) to reach this target. The treatment strategy often follows a protocol for adapting treatment depending on the disease activity level and degree of response to treatment. [Adapted from NICE's guideline on rheumatoid arthritis in adults, recommendations 1.2.1, 1.2.3 and terms used in this guideline]