NICE clinical guidelines
Issued: February 2009 (last modified: August 2013)

Rheumatoid arthritis: The management of rheumatoid arthritis in adults

This is an extract from the guidance. The complete guidance is available at


This guidance updates and replaces 'Guidance on the use of cyclooxygenase (Cox) II selective inhibitors, celecoxib, rofecoxib, meloxicam and etodolac for osteoarthritis and rheumatoid arthritis' (NICE technology appraisal guidance 27) and 'Anakinra for rheumatoid arthritis' (NICE technology appraisal guidance 72).

Rheumatoid arthritis (RA) is an inflammatory disease. It largely affects synovial joints, which are lined with a specialised tissue called synovium. RA typically affects the small joints of the hands and the feet, and usually both sides equally and symmetrically, although any synovial joint can be affected. It is a systemic disease and so can affect the whole body, including the heart, lungs and eyes.

There are approximately 400,000 people with RA in the UK. The incidence of the condition is low, with around 1.5 men and 3.6 women developing RA per 10,000 people per year. This translates into approximately 12,000 people developing RA per year in the UK. The overall occurrence of RA is two to four times greater in women than men. The peak age of incidence in the UK for both genders is the 70s, but people of all ages can develop the disease.

Drug management aims to relieve symptoms, as pain relief is the priority for people with RA, and to modify the disease process. Disease modification slows or stops radiological progression. Radiological progression is closely correlated with progressive functional impairment.

RA can result in a wide range of complications for people with the disease, their carers, the NHS and society in general. The economic impact of this disease includes:

  • direct costs to the NHS and associated healthcare support services

  • indirect costs to the economy, including the effects of early mortality and lost productivity

  • the personal impact of RA and subsequent complications for people with RA and their families.

Approximately one third of people stop work because of the disease within 2 years of onset, and this prevalence increases thereafter. The total costs of RA in the UK, including indirect costs and work-related disability, have been estimated at between £3.8 and £4.75 billion per year. Clearly this disease is costly to the UK economy and to individuals.

NICE has published five technology appraisals relevant to RA. Two of these are updated in this guideline ('Anakinra for rheumatoid arthritis', NICE technology appraisal guidance 72; see section 1.4.3; and 'Guidance on the use of cyclo-oxygenase (Cox) II selective inhibitors, celecoxib, rofecoxib, meloxicam and etodolac for osteoarthritis and rheumatoid arthritis', NICE technology appraisal guidance 27; see section 1.4.4). Recommendations from the other appraisals are incorporated into section 2.

The guideline will assume that prescribers will use a drug's summary of product characteristics to inform their decisions for individual patients.