Treatment Plan
- Refer suspected cases within 3 days
- Initial management:
- NSAIDs + PPI while awaiting appointment
- Secondary care management:
- Monotherapy DMARDs (non-biological): methotrexate, sulfasalazine
- Glucocorticoids for bridging until DMARDs are effective
- Combination DMARDs if needed
- Biological agents with non-biological agent (e.g. methotrexate)
- Annual reviews coordinated by secondary care
- Flare management:
- Seek advice
- Short-term glucocorticoids (e.g. oral prednisolone, IM/IA methylprednisolone)
- Surgical referral indications:
- Worsening joint function
- Progressive deformity
- Persistent localized synovitis
- Tendon ruptures
- Nerve compression
- Stress fractures