Updates

The Rheumatology guidelines have been extensively revised. This update provides current, evidence-based advice on a wide range of rheumatological and musculoskeletal conditions, and principles of use for common therapies used for management.

An expanded suite of assessment topics is designed to help practitioners assess patients with new onset of musculoskeletal symptoms. Guidance is given on assessing for alerting features of serious rheumatological conditions, important components of a patient’s history, when to undertake diagnostic tests and differential diagnoses to consider. A companion topic provides advice on managing suspected inflammatory arthritis, including when to implement urgent management or seek specialist advice.

Determining whether a nonsteroidal anti-inflammatory drug (NSAID) should be used for a patient can be difficult. To help clinicians with this decision, the updated principles topic provides information on assessing an individual’s risk of NSAID adverse effects and how to minimise risk of adverse effects when an NSAID is used. Specific advice is given on NSAID use and choice in patients at increased risk of adverse effects while taking an NSAID (eg people who have an increased cardiovascular risk, older people). Updated advice on NSAID effects on reproductive health is also included.

An increasing number of immunomodulatory drugs are available for the management of autoimmune and autoinflammatory diseases. To support primary care practitioners managing patients treated with these drugs, advice is included on pre-treatment screening, recommended monitoring during treatment, and how to manage intercurrent infection or a patient’s reproductive health. The advice in this topic can be applied to a range of nonrheumatological autoimmune or autoinflammatory conditions (eg psoriasis, inflammatory bowel disease)

A new topic provides guidance on diagnosing and managing the thrombotic and obstetric phenotypes of antiphospholipid syndrome, including recommendations for thromboprophylaxis. The clinical scenarios in which screening for antiphospholipid antibodies is indicated are also described.

The prevalence of gout is increasing. Although recurrent acute episodes are likely unless urate-lowering therapy is used (initially in combination with flare prophylaxis), patients can be reluctant to start treatment. Prompts are included to help practitioners have a discussion with patients about the benefits of long-term treatment. An easy reference guide to the individual components of gout management is also included.

The suite of topics on soft-tissue limb conditions has been extensively revised and now includes topics on acute knee injuries and many paediatric-specific diagnoses (eg benign hypermobility in children and adolescents). For easy reference, a summary of key practice points has been added for each soft-tissue limb condition. The general principles of acute and subacute management of soft-tissue limb conditions have been updated to reflect the newer alternatives to rest, ice, compression and elevation (RICE), which include a focus on protecting the injured part, optimal loading and rehabilitation.

The collection of juvenile idiopathic arthritis (JIA) topics has been expanded and now includes subtype-specific drug recommendations and additional detail on the role of general practitioners in patient management. Uveitis is a common complication of JIA and should be screened for in most patients—a new topic outlines the approach to screening and management. Additionally, to help ensure young adults with rheumatological conditions are effectively managed when they move from paediatric to adult care, content outlining the requirements for effective transition of care has been added.

A new topic on whiplash-associated disorder, a common cause of nonspecific neck pain in primary care, details the recommended multidimensional approach to management to address psychological, motor and sensory issues.

Expanded advice is also included for numerous other conditions managed by rheumatologists, including inflammatory rheumatological conditions (such as rheumatoid arthritis, spondyloarthritis and inflammatory connective tissue diseases ), Behçet syndrome, adult-onset Still disease and immunoglobulin-G₄ related disease.