10.1 Arthritis

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Last edited: 14-02-2024

10.1 Arthritis

First line drugs

Second line drugs

Specialist drugs

Secondary care drugs

Disease-modifying Anti-rheumatic Drugs

Hydroxychloroquine (TLS Red)

Also licensed for active rheumatoid arthritis systemic and discoid lupus erythematosus and dermatological conditions caused or aggravated by sunlight

Interleukin inhibitors (TLS Red)

NHS England Commissioning Board Clinical Commissioning Policy A13/PS/a (specialised rheumatology)
NHS ENGLAND CLINICAL COMMISSIONING POLICY: E03/P/d; TA373

Tocilizumab (TLS Red)

NICE TA375 Tocilizumab for the treatment of systemic juvenile idiopathic arthritis
NICE TA373 Abatacept, adalimumab, etanercept and tocilizumab for treating juvenile idiopathic arthritis NHS England funded as per NICE TA180

T-cell Activation Inhibitors

Abatacept (TLS Red)

For refractory idiopathic inflammatory myopathies see NHS England Commissioning Policy 211002P

Ustekinumab (TLS Red)

NICE TA195 Rheumatoid Arthritis - drugs for treatment after failure of a TNF inhibitor
NICE TA375 Abatacept for treating rheumatoid arthritis after the failure of conventional disease-modifying anti-rheumatic drugs (rapid review of technology appraisal guidance 234)
NICE TA373 Abatacept, adalimumab, etanercept and tocilizumab for treating juvenile idiopathic arthritis

The subcutaneous preparation may be used in preference to the IV preparation in accordance with the NICE TAs 195 and 280. Approved by the BNSSG JFG June 2015.

Tumour Necrosis Factor Alpha (TNF-alpha) Inhibitors

See MHRA drug safety update Tumour necrosis factor alpha inhibitors: risk of tuberculosis

Adalimumab (TLS Red)

NICE TA375 Rheumatoid Arthritis - adalimumab, etanercept, infliximab
NICE TA383 Ankylosing spondylitis
NICE TA195 Rheumatoid Arthritis - drugs for treatment after failure of a TNF inhibitor
NICE TA199 Psoriatic arthritis - treatment
NICE TA373 Abatacept, adalimumab, etanercept and tocilizumab for treating juvenile idiopathic arthritis

Etanercept (TLS Red)

NICE TA373 Etanercept for the treatment of juvenile idiopathic arthritis
NICE TA375 Rheumatoid arthritis - adalimumab, etanercept, infliximab
NICE TA383 Ankylosing spondylitis
NICE TA195 Rheumatoid arthritis - drugs for treatment after failure of a TNF inhibitor
NICE TA199 Psoriatic arthritis - treatment
NICE TA373 Abatacept, adalimumab, etanercept and tocilizumab for treating juvenile idiopathic arthritis

Golimumab (TLS Red)

NICE TA220 Psoriatic arthritis
NICE TA225 Rheumatoid arthritis, after the failure of previous anti-rheumatic drugs
NICE TA383 Ankylosing spondylitis

Infliximab (TLS Red)

NICE TA375 Rheumatoid Arthritis - adalimumab, etanercept, infliximab
NICE TA195 Rheumatoid Arthritis - drugs for treatment after failure of a TNF inhibitor
NICE TA199 Psoriatic arthritis - treatment

Rituximab (TLS Red)

NICE TA195 Rheumatoid Arthritis - drugs for treatment after failure of a TNF inhibitor. Rituximab may also be used in combination with Leflunomide in patients in whom methotrexate is not tolerated, in accordance with NICE TA195 - approved by the BNSSG JFG June 2015.
For the treatment of Anti-neutrophil Cytoplasmic Autoantibody-Associated (ANCA) Vasculitis (AAV) see NHS England Commissioning Board Clinical Commissioning Policy A13/P/a (specialised rheumatology) and NICE TA308 Rituximab in combination with glucocorticoids for treating anti-neutrophil cytoplasmic antibody associated vasculitis
For the treatment of Systemic Lupus Erythematosus in adults and post-pubescent children see NHS England Board Clinical Commissioning Policy
For paediatrics for juvenile arthritis NHS ENGLAND CLINICAL COMMISSIONING POLICY: E03/P/d Drugs affecting the immune response - for specialist use only

Azathioprine (TLS Red)

Ciclosporin (TLS Red)

Cyclophosphamide (TLS Red)

Methotrexate - weekly dose (TLS Amber 1 month) SCP click here

Please refer to NPSA guidance on reducing the risks of oral methotrexate. Patients should have patient held records while they are receiving treatment with any DMARD requiring regular monitoring (record cards and GP protocol advice available from rheumatology)

Mycophenolate (oral) (TLS Red)

Rheumatology uses - unlicensed indication

Protein Kinase Inhibitors

Baricitinib (TLS Red)

For use in monogenic interferonopathies as per NHS England Clinical Commissioning Policy

Tofacitinib (TLS Red)

NICE TA735 Tofacitinib for treating juvenile idiopathic arthritis