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

Bridget Hodkinson, Elsa van Duuren, Clive Pettipher, Asgar Kalla


Updated treatment recommendations for the therapy of rheumatoid arthritis (RA) in South Africa advocate early diagnosis, prompt initiation of disease-modifying anti-rheumatic drugs (DMARDs), and an intense treatment strategy where disease activity is assessed with a composite score such as the Simplified Disease Activity Index (SDAI). Frequent assessments and escalation of therapy are necessary until low disease activity (LDA) (SDAI ≤11) or ideally remission (SDAI ≤3.3) is achieved. Synthetic DMARDs may be used as monotherapy or in combination, and can be co-prescribed with low-dose corticosteroids if necessary. Biologic DMARD therapy should be considered for patients who have failed a 6-month trial of at least 3 synthetic DMARDs. All RA patients in SA are at increased risk of tuberculosis (TB), in particular patients using anti-tumour necrosis factor (TNF) biologic therapy. These recommendations provide practical suggestions for the screening and management of TB and other comorbidities, and offer an approach to monitoring of RA patients.

Authors' affiliations

Bridget Hodkinson, Department of Medicine, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa

Elsa van Duuren, Jacaranda Hospital, Pretoria, South Africa

Clive Pettipher, Wilgeheuwel Hospital, Johannesburg, South Africa

Asgar Kalla, Department of Medicine, Division of Rheumatology, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa

Full Text



rheumatoid arthritis; guideline

Cite this article

South African Medical Journal 2013;103(8):576-585. DOI:10.7196/SAMJ.7047

Article History

Date submitted: 2013-05-13
Date published: 2013-06-14

Article Views

Abstract views: 16124
Full text views: 26984

Comments on this article

*Read our policy for posting comments here