Shared care for rheumatoid arthritis

News release from the National Coordinating Centre for Health Technology Assessment

31 October 2005

Hospital visits for patients with stable established rheumatoid arthritis (RA) could be reduced according to new research commissioned by the HTA programme. Led by Professor Deborah Symmons at the University of Manchester, the research aimed to establish the best environment in which to treat stable, established RA. About one third of all current hospital attendees with RA have stable, established disease. After a clinical trial involving 466 patients from across the UK , the research team concluded that sharing care between hospital and general practitioner was the most effective for patients with stable RA, significantly reducing their need for hospital visits.

The trial involved patients with RA of more than five years duration, on stable therapy, from rheumatology clinics in Stoke on Trent, London, Truro, Macclesfield and Cannock. Patients were treated in two groups, one treated for symptom control at home followed up quarterly by rheumatology nurse specialists and annually by a rheumatologist, and the other treated with aggressive therapies and followed up at least quarterly in hospital. The findings of the research suggested that there were few differences between the results of aggressive or symptomatic treatment. In 58% to 90% of cases the research team found that treatment in the shared care setting was more cost effective than treatment based predominantly in hospital.

"Rheumatoid arthritis is a chronic inflammatory joint condition, yet the best treatment policy for patients with established disease remains unclear," says Professor Symmons. "There is currently no cure for RA so treatment is aimed at controlling pain and stiffness, reducing or preventing joint damage, maximising physical activity and improving quality of life.

"Patients with mild, stable, established RA should be managed in a shared care setting, with annual hospital reviews, quarterly follow-up by a rheumatology specialist nurse, and access to telephone advice and support. This will enable patients with stable RA to initiate changes in their treatment when symptoms deteriorate without the need for frequent hospital assessments."

This research is published in Health Technology Assessment Vol 9.34. The full text of the research monograph is available for download free of charge from http://www.hta.ac.uk/project/991.asp

Notes for editors


  1. The HTA programme is a programme of the National Institute for Health Research (NIHR) and produces high quality research information about the effectiveness, costs, and broader impact of health technologies for those who use, manage and provide care in the NHS. It is the largest of the NIHR programmes and publishes the results of its research in the Health Technology Assessment journal, with more than 400 issues published to date. The journal’s 2007 Impact Factor (3.87) ranked it in the top 10% of medical and health-related journals. All issues are available for download free of charge from the website, www.hta.ac.uk The HTA programme is coordinated by the National Coordinating Centre for Health Technology Assessment (NCCHTA), based at the University of Southampton.
  2. The National Institute for Health Research provides the framework through which the research staff and research infrastructure of the NHS in England is positioned, maintained and managed as a national research facility.  The NIHR provides the NHS with the support and infrastructure it needs to conduct first-class research funded by the Government and its partners alongside high-quality patient care, education and training.  Its aim is to support outstanding individuals (both leaders and collaborators), working in world class facilities (both NHS and university), conducting leading edge research focused on the needs of patients. www.nihr.ac.uk

Contact details

Naomi Stockley, Programme Manager (Communications)
Telephone: 02380 595 646, Email: ns5@soton.ac.uk

Helen Nikandrou, Assistant Programme Manager (Communications)
Telephone: 02380 595 584, Email: h.nikandrou@soton.ac.uk

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