, Management of Rheumatoid Arthritis
Published by:
Malaysia Health Technology Assessment Section (MaHTAS)
Medical Development Division, Ministry of Health Malaysia
Level 4, Block E1, Precinct 1
Federal Government Administrative Centre
62590 Putrajaya, Malaysia
Copyright
The copyright owner of this publication is MaHTAS. Content may be
reproduced in any number of copies and in any format or medium
provided that a copyright acknowledgement to MaHTAS is included and
the content is not changed, not sold, nor used to promote or endorse
any product or service, and not used in an inappropriate or misleading
context.
ISBN: 978-967-2173-82-3
Available on the following websites:
http://www.moh.gov.my
http://www.acadmed.org.my
http://www.msr.my/
Also available as an app for Android and IOS platform: MyMaHTAS
STATEMENT OF INTENT
These clinical practice guidelines (CPG) are meant to be guides for
clinical practice, based on the best available evidence at the time of
development. Adherence to these guidelines may not necessarily
guarantee the best outcome in every case. Every healthcare provider is
responsible for the management of his/her unique patient based on the
clinical picture presented by the patient and the management options
available locally.
, Management of Rheumatoid Arthritis
UPDATING THE CPG
These guidelines were issued in 2019 and will be reviewed in a minimum
period of four years (2023) or sooner if there is a need to do so. When
it is due for updating, the Chairman of the CPG or National Advisor of
the related specialty will be informed about it. A discussion will be done
on the need for a revision including the scope of the revised CPG. A
multidisciplinary team will be formed and the latest systematic review
methodology used by MaHTAS will be employed.
Every care is taken to ensure that this publication is correct in every
detail at the time of publication. However, in the event of errors or
omissions, corrections will be published in the web version of this
document, which is the definitive version at all times. This version can
be found on the websites mentioned above.
, Management of Rheumatoid Arthritis
TABLE OF CONTENTS
No. Title Page
Key Recommendations i
Levels of Evidence and Formulation of Recommendation ii
Guidelines Development and Objectives iii
Development Group vi
Review Committee vii
External Reviewers viii
Algorithm 1. Diagnosis of Rheumatoid Arthritis ix
Algorithm 2. Treatment of Rheumatoid Arthritis x
1. INTRODUCTION 1
2. CLINICAL FEATURES 2
3.INVESTIGATIONS 4
3.1 Laboratory Test 4
3.2 Imaging 5
3.2.1 Plain Radiography 5
3.2.2 Musculoskeletal Ultrasound 6
3.2.3 Magnetic Resonance Imaging 7
4. CLASSIFICATION CRITERIA 8
5. PROGNOSTIC FACTORS 9
6. REFERRAL 10
7.TREATMENT 12
7.1 Non-Pharmacological Treatment 12
7.1.1 Patient Education 12
7.1.2 Occupational Therapy 13
7.1.3 Physiotherapy 13
7.1.4 Podiatry 14
7.1.5 Dietetics 14
7.2 Pharmacological Treatment 14
7.2.1 Non-Steroidal Anti-Inflammatory Drugs 14
7.2.2 Corticosteroids 16
7.2.3 Disease Modifying Anti-Rheumatic Drugs 17
a. Conventional Synthetic DMARDs 18
b. Targeted Synthetic DMARDs 20
c. Biologics 21
d. Biosimilars 25
8. TRADITIONAL AND COMPLEMENTARY MEDICINES 26
Published by:
Malaysia Health Technology Assessment Section (MaHTAS)
Medical Development Division, Ministry of Health Malaysia
Level 4, Block E1, Precinct 1
Federal Government Administrative Centre
62590 Putrajaya, Malaysia
Copyright
The copyright owner of this publication is MaHTAS. Content may be
reproduced in any number of copies and in any format or medium
provided that a copyright acknowledgement to MaHTAS is included and
the content is not changed, not sold, nor used to promote or endorse
any product or service, and not used in an inappropriate or misleading
context.
ISBN: 978-967-2173-82-3
Available on the following websites:
http://www.moh.gov.my
http://www.acadmed.org.my
http://www.msr.my/
Also available as an app for Android and IOS platform: MyMaHTAS
STATEMENT OF INTENT
These clinical practice guidelines (CPG) are meant to be guides for
clinical practice, based on the best available evidence at the time of
development. Adherence to these guidelines may not necessarily
guarantee the best outcome in every case. Every healthcare provider is
responsible for the management of his/her unique patient based on the
clinical picture presented by the patient and the management options
available locally.
, Management of Rheumatoid Arthritis
UPDATING THE CPG
These guidelines were issued in 2019 and will be reviewed in a minimum
period of four years (2023) or sooner if there is a need to do so. When
it is due for updating, the Chairman of the CPG or National Advisor of
the related specialty will be informed about it. A discussion will be done
on the need for a revision including the scope of the revised CPG. A
multidisciplinary team will be formed and the latest systematic review
methodology used by MaHTAS will be employed.
Every care is taken to ensure that this publication is correct in every
detail at the time of publication. However, in the event of errors or
omissions, corrections will be published in the web version of this
document, which is the definitive version at all times. This version can
be found on the websites mentioned above.
, Management of Rheumatoid Arthritis
TABLE OF CONTENTS
No. Title Page
Key Recommendations i
Levels of Evidence and Formulation of Recommendation ii
Guidelines Development and Objectives iii
Development Group vi
Review Committee vii
External Reviewers viii
Algorithm 1. Diagnosis of Rheumatoid Arthritis ix
Algorithm 2. Treatment of Rheumatoid Arthritis x
1. INTRODUCTION 1
2. CLINICAL FEATURES 2
3.INVESTIGATIONS 4
3.1 Laboratory Test 4
3.2 Imaging 5
3.2.1 Plain Radiography 5
3.2.2 Musculoskeletal Ultrasound 6
3.2.3 Magnetic Resonance Imaging 7
4. CLASSIFICATION CRITERIA 8
5. PROGNOSTIC FACTORS 9
6. REFERRAL 10
7.TREATMENT 12
7.1 Non-Pharmacological Treatment 12
7.1.1 Patient Education 12
7.1.2 Occupational Therapy 13
7.1.3 Physiotherapy 13
7.1.4 Podiatry 14
7.1.5 Dietetics 14
7.2 Pharmacological Treatment 14
7.2.1 Non-Steroidal Anti-Inflammatory Drugs 14
7.2.2 Corticosteroids 16
7.2.3 Disease Modifying Anti-Rheumatic Drugs 17
a. Conventional Synthetic DMARDs 18
b. Targeted Synthetic DMARDs 20
c. Biologics 21
d. Biosimilars 25
8. TRADITIONAL AND COMPLEMENTARY MEDICINES 26
