10.1 Drugs use in rheumatic diseases and gout

Non-drug measures, such as education, weight reduction and exercise, are core treatments in osteoarthritis (OA) and should be offered to everyone. See Arthritis Research UK and Arthritis Care for patient information.
The pain toolkit provides self-management advice for people living with persistent pain.
NICE guidance for osteoarthritis recommends paracetamol and/or topical NSAIDs should be considered ahead of oral NSAIDS for pain relief. Refer to NICE CG177 Osteoarthritis Feb 2014.
If a person with osteoarthritis needs to take low-dose aspirin, healthcare professionals should consider other analgesics before substituting or adding an NSAID (+PPI) or COX-2 inhibitor (+ PPI) if pain relief is ineffective or insufficient. Intra-articular corticosteroid injections may produce temporary benefit in osteoarthritis.
There is not enough evidence to justify prescribing glucosamine and rubefacients and they are therefore not recommended for the treatment of osteoarthritis.
NICE do not recommend intra-articular hyaluronan injections for the management of osteoarthritis.
See NICE NG59 on the management of low back pain and sciatica.

If rheumatoid arthritis is suspected, patient should be referred urgently to rheumatology for assessment, management and initiation of DMARDs. Patients should not be managed by non-specialists.

Refer to the following websites for further information and guidelines: NICE Rheumatoid Arthritis Pathway and British Society for Rheumatology.
Risks/benefits of treatments should be discussed with patients before commencing. Some charitable/voluntary sector organisations have developed tools for patient communication, e.g. Arthritis Research UK, Arthritis Care and NRAS.