title: South African recommendations for the management of rheumatoid arthritis: an algorithm for the standard of care in 2013.
abstract: Updated treatment recommendations for the therapy of rheumatoid arthritis (RA) in South Africa advocate early diagnosis, prompt initiation of disease-modifying anti-rheumatic drugs (DMARDs), and an intense treatment strategy where disease activity is assessed with a composite score such as the Simplified Disease Activity Index (SDAI). Frequent assessments and escalation of therapy are necessary until low disease activity (LDA) (SDAI ≤11) or ideally remission (SDAI ≤3.3) is achieved. Synthetic DMARDs may be used as monotherapy or in combination, and can be co-prescribed with low-dose corticosteroids if necessary. Biologic DMARD therapy should be considered for patients who have failed a 6-month trial of at least 3 synthetic DMARDs. All RA patients in SA are at increased risk of tuberculosis (TB), in particular patients using anti-tumour necrosis factor (TNF) biologic therapy. These recommendations provide practical suggestions for the screening and management of TB and other comorbidities, and offer an approach to monitoring of RA patients.
authors.affiliation: Department of Medicine, University of the Witwatersrand, Johannesburg, South Africa. drbridget@gmail.com
authors.forename: Bridget
authors.initials: B
authors.lastname: Hodkinson
authors.forename: Elsa
authors.initials: E
authors.lastname: Van Duuren
authors.forename: Clive
authors.initials: C
authors.lastname: Pettipher
authors.forename: Asgar
authors.initials: A
authors.lastname: Kalla
mesh_terms: D000465:Algorithms; D000700:Analgesics / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D018501:Antirheumatic Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000145:classification / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000628:therapy*; D001691:Biological Therapy; D015658:HIV Infections / Q000150:complications; D006801:Humans; D010024:Osteoporosis / Q000150:complications; D018570:Risk Assessment; D012307:Risk Factors; D013019:South Africa; D014376:Tuberculosis / Q000453:epidemiology
chemical_list: D000700:Analgesics; D000894:Anti-Inflammatory Agents, Non-Steroidal; D018501:Antirheumatic Agents