South African recommendations for the management of rheumatoid arthritis: An algorithm for the standard of care in 2013

By on November 25, 2015

Rheumatoid arthritis (RA) is a chronic inflammatory disease, which, if treated inadequately, leads to irreversible joint damage, resulting in deformities, disability and premature mortality. The disease occurs worldwide and affects approximately 1% of the population.[1,2]

Recently, there have been major developments in the management of RA. These include (i) advances in the early diagnosis of the disease and evidence for the benefit of early therapy; (ii) better tools to assess response to therapy with the development of composite disease activity scores, allowing goal-directed therapy where the target is remission; and (iii) the emergence of biologic disease-modifying anti-rheumatic drugs (DMARDs). These strategies result in better control of inflammation, thus preventing joint damage and reducing disability. Against this background, the South African Rheumatism and Arthritis Association (SARAA) has proposed the development of an updated treatment strategy for the effective therapy of RA in South Africa (SA). These recommendations are aimed at all healthcare professionals managing RA, including rheumatologists, physicians, general practitioners, nurses and allied healthcare professionals.

SARAA adhered to the following ideologies when formulating these
• They should be aimed at all healthcare professionals managing RA, including allied healthcare professionals, nurses, general practitioners, physicians and rheumatologists.
• There should be consultation with pivotal stakeholders in the final consensus of the document.
• They should be based on scientific evidence or, if unavailable, expert consensus.
• They should be recommendations and not a guideline. Management of RA is not cast in stone (and is likely to change again in the near future) and failure to adhere to them is not incriminating or negligent.

Download Full Rheumatoid Arthritis SA Recommendations article (PDF)

Dr Clive Pettipher is a leading expert in the field of Arthritis and Rheumatology and established Cape Arthritis and Rheumatology in 2015 in the iconic Busamed Hospital.

He qualified as a specialist physician in Johannesburg in 1998 and rheumatologist in 2000. He completed his fellowship at Chris Hani Baragwanath Hospital, acquiring invaluable training.

He started a private practice at Wilgeheuwel Hospital in 2001 until 2014 in rheumatology. He ran a large biologics clinic with over 200 patients on these life changing therapies. His ongoing special interests include the following
• research in biological therapies in South Africa and currently manages the South African Biologics Registry (SABIO).
• Musculoskeletal imaging - ultrasound of tendons and joints related to rheumatology - trained overseas by the European League Against Rheumatism.

He is honored to be a recent president of the South African Rheumatism and Arthritis Association (SARAA) during which time he published the South African Recommendations for the Management of Rheumatoid Arthritis: 'An algorithm for the standard of care in 2013', SAMJ.

He has also published various articles on tuberculosis in international journals and was awarded the Solly Herwitz academic prize for his research and the best MMed in 2000 at the University of the Witwatersrand. He is currently an advisory board member for Roche, Abbvie and Jansen Pharmaceuticals.