Shanti Nursing Home

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Shanti Nursing Home

(A Multispeciality Hospital)

Rheumatoid arthritis (RA) is an ongoing fundamental sickness. Early finding of RA and powerful treatment with disease-modifying antirheumatic drugs (DMARDs) are fundamental to diminish joint annihilation and inability. A rising scope of DMARDs is presently accessible.

Late analysis of RA incredibly expands the gamble of erosive joint harm. When mechanical harm has happened, torment and joint distortion frequently require helps and apparatuses and, in the end, medical procedure. Ebb and flow direction is that patients with thought RA ought to be alluded to a rheumatologist as quickly as time permits so sickness changing specialists can be begun right on time in the condition. The open door where infection changing medications can forestall joint harm is a couple of months


  • In people with recent-onset active RA, measure CRP and key components of disease activity (using a composite score such as DAS28) monthly until treatment has controlled the disease to a level previously agreed with the person with RA.
  • The DAS28 is a measure of disease activity in RA. The score is calculated by a complex mathematical formula, which includes the number of tender and swollen joints (out of a total of 28 – shoulders, elbows, wrists, metacarpophalangeal joints, proximal interphalangeal joints and the knees), the ESR, and the patient’s ‘assessment of global health’. A DAS28 score greater than 5.1 implies active disease, less than 3.2 – well-controlled disease, and less than 2.6 – remission
  • creen for comorbid conditions – eg, osteoporosis, depression, infection and cardiovascular disease (CVD).

Non-drug management

The importance of the MDT is emphasised in the NICE guidance[3]:

  • RA patients should have access to a named member of the MDT who is responsible for co-ordinating their care (often a specialist nurse).
  • RA patients should have easy access to physiotherapy, occupational therapy, psychological services and podiatry. There should be regular review, particularly with physiotherapy and occupational therapy.
  • The core members of the MDT will be the GP, the rheumatologist, physiotherapists and occupational therapists. Other specialties that may need to be involved include podiatrists, orthotists, dieticians, pharmacists and neurologists.
  • Exercise has been found to reduce bone loss in premenopausal women with RA.
  • Pain clinic specialists may be able to advise on non-drug management options, such as transcutaneous electrical nerve stimulation (TENS) and behavioural approaches.
  • Non-clinical issues may need the assistance of social workers, voluntary organisations and wheelchair services.


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