[2009], 1.8.9 Inform adults with RA who wish to try complementary therapies that although some may provide short-term symptomatic benefit, there is little or no evidence for their long-term efficacy. 1.5.5 In adults with established RA, only continue long-term treatment with glucocorticoids when: the long-term complications of glucocorticoid therapy have been fully discussed, and, all other treatment options (including biological and targeted synthetic DMARDs) have been offered. Occupational therapy (OT), with the aim to facilitate task performance and to decrease the consequences of rheumatoid arthritis for daily life activities, is considered to be a cornerstone in the management of rheumatoid arthritis. Arthritis Rheum 2002; 47:672. Sorted by During treatment with 2 or more DMARDs, tapering and stopping at least 1 drug once disease is adequately controlled. This guideline covers diagnosing and managing rheumatoid arthritis. Finding more information and committee details, 1.1 Referral, diagnosis and investigations, conventional disease-modifying anti-rheumatic drugs, guideline on depression in adults with a chronic physical health problem. It focuses on diagnosis, early management, and co-ordination of... Click export CSV or RIS to download the entire page or use the checkbox in each result to select a subset of records to download. Published Guidance; Rheumatoid arthritis in adults: management. Occupational Therapy for Arthritis OTs can help you develop and implement a plan to treat the challenges of everyday life. 2 Trafford General Hospital, Manchester University NHS Foundation Trust, Manchester M41 5SL, UK … Glucocorticoids used for a short period of time when a person is starting a new DMARD, intended to improve symptoms while waiting for the new DMARD to take effect (which can take 2 to 3 months). Consider hydroxychloroquine for first-line treatment as an alternative to oral methotrexate, leflunomide or sulfasalazine for mild or palindromic disease. NICE has published technology appraisal guidance on biological and targeted synthetic DMARDs for RA. How occupational therapy can help those living with rheumatoid arthritis Rheumatoid arthritis (RA) is an autoimmune, chronic inflammatory condition that primarily affects the joints of the body. Therefore, patients should continue therapy with anakinra until they and their consultant consider it is appropriate to stop. Sorted by Relevance ... Everything NICE has said on managing rheumatoid arthritis … This guidance has been updated and replaced by NICE guideline … Occupational therapy can be very useful for patients with RA. persons with rheumatoid arthritis (RA) the physical, personal, familial, social and vocational consequences are extensive.... Rheumatoid Arthritis Occupational therapy for rheumatoid arthritis... evidence base for vocational rehabilitation for people with inflammatory arthritis is of low quality. 1.6.2 When treating symptoms of RA with oral NSAIDs: offer the lowest effective dose for the shortest possible time, review risk factors for adverse events regularly. A. Abdominal aortic aneurysm; Abortion care; Accident prevention (see unintentional injuries among under-15s) Acute coronary syndromes: early management; Acute coronary syndromes: RA typically presents as inflammatory arthritis affecting the small joints of the hands and the feet … If you want to: Consider these activity tips: An occupational therapy practitioner offers expertise to: Reduce pressure and discomfort in your hands when holding or working with objects. [2009]. Additional DMARDs are added to DMARD monotherapy when disease is not adequately controlled. [2009]. [2009, amended 2018], 1.6.1 Consider oral non-steroidal anti-inflammatory drugs (NSAIDs, including traditional NSAIDs and cox II selective inhibitors), when control of pain or stiffness is inadequate. An occupational therapist (OT) is a specialist who helps people with arthritis… Refer urgently (even with a normal acute-phase response, negative anti-cyclic citrullinated peptide [CCP] antibodies or rheumatoid factor) if any of the following apply: 1.1. the small joints of the hands or feet a… Arthritic joints can't tolerate as much stress as healthy joints. [2009, amended 2018]. A treat-to-target strategy is a strategy that defines a treatment target (such as remission or low disease activity) and applies tight control (for example, monthly visits and respective treatment adjustment) to reach this target. BMJ 2018; 362 doi: ... occupational therapy arthritis in hands Osteoarthritis (OA) is the most common form of arthritis … Macedo AM, Oakley SP, Panayi GS, Kirkham BW. How occupational therapy can help those living with rheumatoid arthritis Rheumatoid arthritis (RA) is an autoimmune, chronic inflammatory condition that primarily affects the joints of the body. [2018], 1.2.3 In adults with active RA, measure C-reactive protein (CRP) and disease activity (using a composite score such as DAS28) monthly in specialist care until the target of remission or low disease activity is achieved. [2009]. Conventional … The Scottish Intercollegiate Guidelines Network (SIGN) develops evidence based clinical practice guidelines for the... A treat to target strategy is used the aim is to achieve a target of remission or low disease activity if remission cannot be achieved. The hallmark feature of this condition is persistent symmetric polyarthritis (synovitis) that affects the … This guideline covers diagnosing and managing rheumatoid arthritis. The following further evaluations, including cost-effectiveness studies, should take place in people with rheumatoid arthritis: Comprehensive occupational therapy interventions The usefulness of work rehabilitation programmes… [2009, amended 2018], To find out why the committee made the 2018 recommendations on symptom control and how they might affect practice, see rationale and impact, 1.7.1 Adults with RA should have ongoing access to a multidisciplinary team. In July 2018, the National Institute for Health and Care Excellence (NICE) published revised guidelines for the management of rheumatoid arthritis (RA) disease in adults. [2009], 1.3.3 Adults with RA who wish to know more about their disease and its management should be offered the opportunity to take part in existing educational activities, including self-management programmes. Published by Scottish Intercollegiate Guidelines Network (SIGN), 01 February 2011. [2009]. arthritis, gout, rheumatoid arthritis, and systemic lupus erythematosus (SLE or lupus). [2009], 1.8.6 Functional insoles and therapeutic footwear should be available for all adults with RA if indicated. [2018], To find out why the committee made the 2018 recommendations on cDMARDs and how they might affect practice, see rationale and impact. The treatment strategy often follows a protocol for treatment adaptations depending on the disease activity level and degree of response to treatment. 1.8.2 Adults with RA should have access to specialist occupational therapy, with periodic review (see 1.9.2 and 1.9.3), if they have: difficulties with any of their everyday activities, or. Conventional disease-modifying anti-rheumatic drugs are synthetic drugs that modify disease rather than just alleviating symptoms. Between attacks the joints return to normal. occupational therapy arthritis in hands + occupational therapy arthritis in hands 21 Nov 2020 Practice Guidelines. Wrap foam, … [2009], 1.7.2 Adults with RA should have access to a named member of the multidisciplinary team (for example, the specialist nurse) who is responsible for coordinating their care. [2009], 1.10.6 Do not let concerns about the long-term durability of prosthetic joints influence decisions to offer joint replacements to younger adults with RA. These recommendations are based on the National Institute for Health and Care Excellence (NICE) guideline Rheumatoid arthritis in adults: management [NICE, 2018a], the NICE pathway Drug treatment for rheumatoid arthritis [NICE, 2018e], the American College of Rheumatology (ACR) Guideline for the treatment of rheumatoid arthritis … Guidance. 1 National Guideline Centre, Royal College of Physicians, London NW1 4LE, UK. Wrap foam, … Your doctor may suggest wearing a splint to properly support certain joints. There is plenty of research to show the effectiveness of occupational therapy in improving functional ability of rheumatoid arthritis … [2018], To find out why the committee made the 2018 recommendations on treat-to-target strategy and how they might affect practice, see rationale and impact, 1.3.1 Explain the risks and benefits of treatment options to adults with RA in ways that can be easily understood. 12 October 2020. Rheumatoid arthritis Everything NICE has said on managing rheumatoid arthritis in adults in an interactive flowchart ... (MND) multidisciplinary team clinic services against NICE guidelines in a University Health Board ... from the physiotherapy or occupational therapy … NICE has published a guideline on depression in adults with a chronic physical health problem. The following further evaluations, including cost-effectiveness studies, should take place in people with rheumatoid arthritis: Comprehensive occupational therapy interventions The usefulness of work rehabilitation programmes… Return promptly to the previous DMARD regimen if the treatment target is no longer met. … Adults with RAshould have access to specialist occupational therapy, with periodic review, if they have: difficulties with any of their everyday activities, OR problems with hand function. They include methotrexate, sulfasalazine, leflunomide and hydroxychloroquine, but do not include biological DMARDs and targeted synthetic DMARDs. Evidence-based information on occupational therapy rheumatoid arthritis from hundreds of trustworthy sources for health and social care. Rheumatoid arthritis: Summary Rheumatoid arthritis (RA) is a chronic systemic inflammatory disease. Occupational therapy (OT), with the aim to facilitate task performance and to decrease the consequences of rheumatoid arthritis for daily life activities, is considered to be a cornerstone in the management of rheumatoid arthritis. This Australian guideline presents recommendations to assist GPs in managing patients with rheumatoid arthritis (RA). The Scottish Intercollegiate Guidelines Network (SIGN) develops evidence based clinical practice guidelines … Everything NICE has said on managing rheumatoid arthritis in adults in an interactive flowchart. Offer first-line treatment … 1.1.6 If anti-CCP antibodies are present or there are erosions on X-ray: advise the person that they have an increased risk of radiological progression but not necessarily an increased risk of poor function, and, emphasise the importance of monitoring their condition, and seeking rapid access to specialist care if disease worsens or they have a flare. The best … [2009], 1.5.3 Do not offer the combination of tumour necrosis factor-α (TNF-α) inhibitor therapy and anakinra for RA. This guideline … Relevance Last updated: The 2009 guideline committee reviewed the evidence on anakinra and incorporated the recommendations into the guideline. [2009]. Showing results 1 to 10. 1.3 Communication and education. A therapist will check to see what you need help with. ... 317 results for guideline on occupational therapy for rheumatoid arthritis. 1 Some … [2009]. Evidence-based information on guideline on occupational therapy for rheumatoid arthritis from hundreds of trustworthy sources for health and social care. Evidence-based information on occupational therapy rheumatoid arthritis from hundreds of trustworthy sources for health and social care. Patients with rheumatoid arthritis should have access to a multidisciplinary team, and may benefit from physiotherapy to encourage exercise, enhance flexibility of joints and strengthen muscles. Guidelines for the management of rheumatoid arthritis (RA) produced by expert groups based on assessments of the research evidence have been produced for over 25 years [1,2,3,4].They … This guideline covers diagnosing and managing rheumatoid arthritis. 1.8.1 Adults with RA should have access to specialist physiotherapy, with periodic review (see 1.9.2 and 1.9.3), to: improve general fitness and encourage regular exercise, learn exercises for enhancing joint flexibility, muscle strength and managing other functional impairments, learn about the short-term pain relief provided by methods such as transcutaneous electrical nerve stimulators (TENS) and wax baths. If you want to: Consider these activity tips: An occupational therapy practitioner offers expertise to: Reduce pressure and discomfort in your hands when holding or working with objects. We reviewed the efficacy of occupational therapy–related interventions for adults with rheumatoid arthritis. Guidance, advice and information services for health, public health and social care professionals. Occupational therapy helps minimize pain and swelling in the joints, while maintaining strength and joint movement. [2018]. 1.1.2 Offer to carry out a blood test for rheumatoid factor in adults with suspected rheumatoid arthritis (RA) who are found to have synovitis on clinical examination. The technology appraisal was then withdrawn. Functional and work outcomes improve in patients with rheumatoid arthritis who receive targeted, comprehensive occupational therapy. Published date: [2018], 1.9.5 Do not use ultrasound for routine monitoring of disease activity in adults with RA. However, they could be encouraged to follow the principles of a Mediterranean diet (more bread, fruit, vegetables and fish; less meat; and replace butter and cheese with products based on vegetable and plant oils). [2018]. 1.10.1 Offer to refer adults with RA for an early specialist surgical opinion if any of the following do not respond to optimal non-surgical management: persistent pain due to joint damage or other identifiable soft tissue cause. 11 July 2018 1.9.3 Offer all adults with RA, including those who have achieved the treatment target, an annual review to: assess disease activity and damage, and measure functional ability (using, for example, the Health Assessment Questionnaire [HAQ]), check for the development of comorbidities, such as hypertension, ischaemic heart disease, osteoporosis and depression, assess symptoms that suggest complications, such as vasculitis and disease of the cervical spine, lung or eyes, organise appropriate cross referral within the multidisciplinary team, assess the need for referral for surgery (see section 1.10), assess the effect the disease is having on a person's life.Follow recommendation 1.2.1 if the target is not maintained. This article summarises the update of the National Institute for Health and Care Excellence (NICE) guideline for the diagnosis and management of rheumatoid arthritis in adults.2 The management of rheumatoid arthritis has evolved in the nine years since the previous NICE guideline on rheumatoid arthritis … Clinical guideline [CG79] Published date: 25 February 2009 Last updated: 09 December 2015. Refer urgently (even with a normal acute-phase response, negative anti-cyclic citrullinated peptide [CCP] antibodies or rheumatoid factor) if any of the following apply: 1.1. the small joints of the hands or feet ar… Guideline 123: Management of early rheumatoid arthritis - Full guideline. 1.5.1 On the balance of its clinical benefits and cost effectiveness, anakinra is not recommended for the treatment of RA, except in the context of a controlled, long-term clinical study. Evidence-based information on guideline on occupational therapy for rheumatoid arthritis from hundreds of trustworthy sources for health and social care. Arthritis … Achieving the target may involve trying multiple conventional disease-modifying anti-rheumatic drugs (cDMARDs) and biological DMARDs with different mechanisms of action, one after the other. [2009]. The role of occupational therapy in the treatment of rheumatoid arthritis is to improve or maintain the patient's maximum level of functioning. Refer for specialist opinion any adult with suspected persistent synovitis of undetermined cause. The overall goal of the treatment is to minimize … 1.1.5 As soon as possible after establishing a diagnosis of RA: measure anti-CCP antibodies, unless already measured to inform diagnosis, X-ray the hands and feet to establish whether erosions are present, unless X-rays were performed to inform diagnosis, measure functional ability using, for example, the Health Assessment Questionnaire (HAQ), to provide a baseline for assessing the functional response to treatment. [2018], To find out why the committee made the 2018 recommendations on short-term bridging treatment with glucocorticoids and how they might affect practice, see rationale and impact, 1.4.3 Offer additional cDMARDs (oral methotrexate, leflunomide, sulfasalazine or hydroxychloroquine) in combination in a step-up strategy when the treatment target (remission or low disease activity) has not been achieved despite dose escalation. nice rheumatoid arthritis guidelineshow to nice rheumatoid arthritis guidelines for Mind/body therapy: Mind/body therapies can help with stress management, plus improve sleep and how you react to pain. A summary of prescribing recommendations from NICE guidance NICE Bites July/August 2018: No 109 Rheumatoid arthritis in adults: management NICE NG100; 2018 This guideline covers the diagnosis and management of rheumatoid arthritis … This article summarises the update of the National Institute for Health and Care Excellence (NICE) guideline for the diagnosis and management of rheumatoid arthritis in adults.2 The management of rheumatoid arthritis has evolved in the nine years since the previous NICE guideline on rheumatoid arthritis … Sort by Date. [2009]. [2009, amended 2018]. People have the right to be involved in discussions and make informed decisions about their care, as described in making decisions about your care. Evidence-based information on guideline on occupational therapy for rheumatoid arthritis from hundreds of trustworthy sources for health and social care. It aims to improve quality of life by ensuring that people with rheumatoid arthritis have the right treatment to slow the progression … [2009], 1.8.7 Offer psychological interventions (for example, relaxation, stress management and cognitive coping skills [such as managing negative thinking]) to help adults with RA adjust to living with their condition. Treatment should be started as soon as possible, ideally within 3 months of onset of persistent symptoms, and the dose should be titrated to the maximum tolerated effective dose. The overall goal of the treatment … 2 Trafford General Hospital, Manchester University NHS Foundation Trust, Manchester M41 5SL, UK … [2009, amended 2020], 1.9.4 For adults who have maintained the treatment target (remission or low disease activity) for at least 1 year without glucocorticoids, consider cautiously reducing drug doses or stopping drugs in a step-down strategy. NICE guideline [NG100] The Scottish Intercollegiate Guidelines Network (SIGN) develops evidence based clinical practice guidelines … 1.9.1 Ensure that all adults with RA have: rapid access to specialist care for flares, information about when and how to access specialist care, and, 1.9.2 Consider a review appointment to take place 6 months after achieving treatment target (remission or low disease activity) to ensure that the target has been maintained. 1.8.8 Inform adults with RA who wish to experiment with their diet that there is no strong evidence that their arthritis will benefit. 1.10.5 If an adult with RA develops any symptoms or signs that suggest cervical myelopathy (for example, paraesthesia, weakness, unsteadiness, reduced power, extensor plantars): refer for a specialist surgical opinion. 1 National Guideline Centre, Royal College of Physicians, London NW1 4LE, UK. Occupational therapy provides assistance to persons whose functional level of performance has been affected by physical, psychological, or developmental disabilities. Sorted by Relevance ... Everything NICE has said on managing rheumatoid arthritis … Palindromic rheumatism is an inflammatory arthritis that causes attacks of joint pain and swelling similar to RA. Published by Royal Australian College of General Practitioners, 01 August 2009. Occupational therapy helps minimize pain and swelling in the joints, while maintaining strength and joint movement. [2009], 1.5.2 Patients currently receiving anakinra for RA may suffer loss of wellbeing if their treatment were discontinued at a time they did not anticipate. There is plenty of research to show the effectiveness of occupational therapy in improving functional ability of rheumatoid arthritis … 1. Psychological interventions … 1.8.10 If an adult with RA decides to try complementary therapies, advise them: these approaches should not replace conventional treatment, this should not prejudice the attitudes of members of the multidisciplinary team, or affect the care offered. METHOD. The role of occupational therapy in the treatment of rheumatoid arthritis is to improve or maintain the patient's maximum level of functioning. It aims to improve quality of life by ensuring that people with rheumatoid arthritis have the right treatment to slow the... range and efficacy of methods used in contrast bath procedures for hand therapy. We reviewed the efficacy of occupational therapy–related interventions for adults with rheumatoid arthritis. [2015], 1.8.5 All adults with RA and foot problems should have access to a podiatrist for assessment and periodic review of their foot health needs (see 1.9.2 and 1.9.3). | Recommendations 1.1 Referral, diagnosis and investigations. [2015], 1.8.4 The tailored hand exercise programme for adults with RA should be delivered by a practitioner with training and skills in this area. 1.4 Initial pharmacological management. 1.1.1 Refer for specialist opinion any adult with suspected persistent synovitis of undetermined cause. Occupational therapy for rheumatoid arthritis is a topic covered in the Evidence-Based Medicine Guidelines.. To view the entire topic, please sign in or purchase a subscription.. Joint protection is a proven strategy to help you manage rheumatoid arthritis pain and perform daily activities more easily. Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations, and has information about prescribing medicines (including off-label use), professional guidelines, standards and laws (including on consent and mental capacity), and safeguarding. Take account of potential gastrointestinal, liver and cardio-renal toxicity, and the person's risk factors, including age and pregnancy. View options for downloading these results. These recommendations are based on the National Institute for Health and Care Excellence (NICE) guideline Rheumatoid arthritis in adults: management [NICE, 2018a], the NICE pathway Drug treatment for rheumatoid arthritis [NICE, 2018e], the American College of Rheumatology (ACR) Guideline for the treatment of rheumatoid arthritis … We examined 51 Level I studies (19 physical activity, 32 … Steultjens EM, Dekker J, Bouter LM, et al. [2009], 1.10.4 Offer urgent combined medical and surgical management to adults with RA who have suspected or proven septic arthritis (especially in a prosthetic joint). Consider short-term bridging treatment with glucocorticoids (oral, intramuscular or intra-articular) when starting a new cDMARD. If the following investigations are ordered in primary care, they should not delay referral for specialist opinion (see recommendation 1.1.1). . Occupational therapy can be very useful for patients with RA. [2009], 1.1.3 Consider measuring anti-CCP antibodies in adults with suspected RA if they are negative for rheumatoid factor. We examined 51 Level I studies (19 physical activity, 32 … Evidence-based information on guideline on occupational therapy for rheumatoid arthritis from hundreds of trustworthy sources for health and social care. Rheumatoid arthritis (RA) is a chronic systemic inflammatory disease of unknown cause. Evidence Central is an … For guidance on using DMARDs to achieve treatment targets, see recommendation 1.2.1. Results for guideline on occupational therapy for rheumatoid arthritis 11 ... NICE - 28 February 2017. 1.4.2 1.10.2 Offer to refer adults with any of the following complications for a specialist surgical opinion before damage or deformity becomes irreversible: nerve compression (for example, carpal tunnel syndrome). Your doctor may suggest wearing a splint to properly support certain joints. ... 302 results for guideline on occupational therapy for rheumatoid arthritis. It aims to improve quality of life by ensuring that people with rheumatoid arthritis have the right treatment to … [2009]. For full details, see the NICE Pathway on rheumatoid arthritis. [2018, amended 2020], 1.2.2 Consider making the target remission rather than low disease activity for people with an increased risk of radiological progression (presence of anti-CCP antibodies or erosions on X-ray at baseline assessment). 1. An occupational therapist can then evaluate your range of motion, muscle strength, and pain levels to … This should provide the opportunity for periodic assessments (see 1.9.2 and 1.9.3) of the effect of the disease on their lives (such as pain, fatigue, everyday activities, mobility, ability to work or take part in social or leisure activities, quality of life, mood, impact on sexual relationships) and help to manage the condition. Occupational therapy … 1 Some clinicians will … An occupational therapist can then evaluate your range of motion, muscle strength, and pain levels to … 1.4.1 For adults with newly diagnosed active RA: Offer first-line treatment with cDMARD monotherapy using oral methotrexate, leflunomide or sulfasalazine as soon as possible and ideally within 3 months of onset of persistent symptoms. In July 2018, the National Institute for Health and Care Excellence (NICE) published revised guidelines for the management of rheumatoid arthritis (RA) disease in adults. 1.8.3 Consider a tailored strengthening and stretching hand exercise programme for adults with RA with pain and dysfunction of the hands or wrists if: they are not on a drug regimen for RA, or, they have been on a stable drug regimen for RA for at least 3 months. Refer for specialist opinion any adult with suspected persistent synovitis of undetermined cause. A. Abdominal aortic aneurysm; Abortion care; Accident prevention (see unintentional injuries among under-15s) Acute coronary syndromes: early management; Acute coronary syndromes: For persons with rheumatoid arthritis (RA) the physical, personal, familial, social and vocational consequences are extensive. For persons with rheumatoid arthritis (RA) the physical, personal, familial, social and vocational consequences are extensive. METHOD. 1.10.3 When surgery is offered to adults with RA, explain that the main expected benefits are: improvement, or prevention of further deterioration, of joint function, and, prevention of deformity.Cosmetic improvements should not be the dominant concern. [2009], 1.5.4 Offer short-term treatment with glucocorticoids for managing flares in adults with recent-onset or established disease to rapidly decrease inflammation. Refer urgently (even with a normal acute-phase response, negative anti-cyclic citrullinated peptide [CCP] antibodies or rheumatoid factor) if any of the following apply: the small joints of the hands or feet are affected, there has been a delay of 3 months or longer between onset of symptoms and seeking medical advice. [2009]. This CKS topic is based on the National Institute for Health and Care Excellence (NICE) guidelines Rheumatoid arthritis in adults: management [NICE, 2018a], ... occupational therapy and podiatry … [2018], To find out why the committee made the 2018 recommendations on monitoring and how they might affect practice, see rationale and impact. [2018], 1.6.3 If a person with RA needs to take low-dose aspirin, healthcare professionals should consider other treatments before adding an NSAID (with a PPI) if pain relief is ineffective or insufficient. Guideline 123: Management of early rheumatoid arthritis - Full guideline. Occupational Therapy for Rheumatoid Arthritis This helps you stay independent. Throughout the course of their disease, offer them the opportunity to talk about and agree all aspects of their care, and respect the decisions they make. [2018], To find out why the committee made the 2018 recommendations on investigations following diagnosis and how they might affect practice, see rationale and impact, 1.2.1 Treat active RA in adults with the aim of achieving a target of remission or low disease activity if remission cannot be achieved (treat-to-target). These conditions present with symptoms such as joint and muscle pain, morning stiffness, swelling, and fatigue. 1.3.2 Offer verbal and written information to adults with RA to: improve their understanding of the condition and its management, and, counter any misconceptions they may have. (2011) Guideline 123: Management of early rheumatoid arthritis - Full guideline. Prescribing and Technical Information (13), British Orthopaedic Association - BOA (1), British Society for Rheumatology - BSR (2), Cochrane Central Register of Controlled Trials (1), Cochrane Database of Systematic Reviews (2), Database of Abstracts of Reviews of Effects - DARE (7), electronic Medicines Compendium - eMC (13), European Centre for Disease Prevention and Control (2), European League Against Rheumatism - EULAR (6), Evidence for Policy and Practice Information and Co-ordinating Centre - EPPI-Centre (1), International Association for the Study of Pain (4), International Longevity Centre UK - ILCUK (1), National Institute for Health and Care Excellence - NICE (17), National Institute for Health Research - NIHR (11), National Rheumatoid Arthritis Society - NRAS (19), NHS Economic Evaluation Database - NHS EED (2), NIHR Journals Library - Health Services and Delivery Research (4), NIHR Journals Library - Public Health Research (1), Royal College of Physicians of London - RCP (3), Royal College of Psychiatrists - RCPsych (1), Scottish Intercollegiate Guidelines Network - SIGN (5), WHO Regional Office for Europe - WHO Europe (18), View options for downloading these results, Vocational rehabilitation in relation to health outcomes and non-health outcomes for people with inflammatory, A systematic review of the effectiveness of contrast baths, Clinical guideline for the diagnosis and management of early. , they should not delay referral for specialist opinion any adult with suspected RA persistent! 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