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Clinical guidelines

Clinical guideline for the diagnosis and management of early rheumatoid arthritis

August 2009

Chronic disease is a major public health burden on Australian society. An increasing proportion of the population has risk factors for, or at least one, chronic disease, leading to increasing public health costs. Health service policy and delivery must address not only acute conditions, but also effectively respond to the wide range of health and public services required by people with chronic illness. Strong primary health care policy is an important foundation for a successful national health delivery system and long term management of public health. It is also linked to practical outcomes, including lower mortality, decreased hospitalisation and improved health outcomes. National strategic health policy has recently given increased recognition to the importance of chronic disease management, with federal government endorsement of a number of initiatives for the prevention or delay in onset, early detection, and evidence based management of chronic diseases, including rheumatoid arthritis (RA).

Chronic musculoskeletal conditions, including arthritis, account for over 4% of the national disease burden in terms of disability adjusted life years. In 2007, the total cost of arthritis to the Australian economy was estimated to be $23.9 billion, an increase of more than $4 billion on the cost calculated in 2004. Access Economics estimated that, in 2007, the allocated health system expenditure associated with arthritis was $4.2 billion or $1100 per person with arthritis. Expenditure allocated to RA was more than $400 million. Rheumatoid arthritis exerts a significant burden on the individual and community due to its impact on patients’ quality of life as a result of the chronic, painful and disabling character of the condition; the diminished employment capacity of many affected individuals; and increased health care costs. For further details refer to the Evidence to support the National Plan for Osteoarthritis, Rheumatoid Arthritis and Osteoporosis: opportunities to improve health related quality of life and reduce the burden of disease and disability.

As such, Australian Government health policy has identified arthritis as a National Health Priority Area and adopted a number of initiatives aimed at: decreasing the burden of chronic disease and disability, raising awareness of preventive disease factors, providing access to evidence based knowledge, and improving the overall management of arthritis within the community. In 2002, all Australian health ministers designated arthritis and musculoskeletal conditions as Australia’s seventh National Health Priority Area. In response, a National Action Plan was developed in 2004 by the National Arthritis and Musculoskeletal Conditions Advisory Group (NAMSCAG). The aim of this document was to provide a blueprint for national initiatives to improve the health related quality of life of people living with osteoarthritis, RA and osteoporosis; reduce the cost and prevalence of these conditions; and to reduce the impact on individuals, their carers and communities within Australia. The National Action Plan was developed to complement both the National Chronic Disease Strategy (which is broader) and the National Service Improvement Framework for Osteoarthritis, Rheumatoid Arthritis and Osteoporosis, and other national and state/territory structures. As part of the Australian Government’s Better Arthritis and Osteoporosis Care (BAOC) 2006–2007 budget initiative, guidelines for the management of osteoarthritis, RA, and juvenile idiopathic arthritis have been developed to inform evidence based primary care of chronic disease in general practice.

Expiry date for the recommendations

This guideline presents a comprehensive review of pharmacological and non-pharmacological management of early RA within the Australian health care context, based on the best available evidence available up to December 2006. Evidence published after this date has not been reviewed for the guideline.

The guideline was approved by the CEO of the National Health and Medical Research Council (NHMRC) on 12 June 2009, under section 14A of the National Health and Medical Research Council Act 1992. Approval for the guideline by the NHMRC is granted for a period not exceeding 5 years. It is expected that the guideline will be reviewed, and revised if necessary, no less than once every 5 years. Review should be more frequent in areas where clinical practice or research is known to be changing rapidly. Readers should check with The Royal Australian College of General Practitioners (RACGP) for any reviews or updates of this guideline.

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