Rheumatoid arthritis is the most common inflammatory disease of the joints affecting about 0.5% of adults, women more often than men with a peak age of onset of 35–45 years. It is usually progressive affecting further joints and the destructive disease process causes irreversible bony erosions and the joints become structurally deformed, with long-term pain and disability. It has an early and significant impact on the person’s ability to work and socio-economic status with work capacity restricted in a third within a year and within 3 years almost half 40 may be registered work disabled.

The aims of management of rheumatoid arthritis are to reduce pain an inflammation; reduce disability; prevent joint damage and progression; and to reduce the comorbidities that are associated with the disease. As joint damage is irreversible it is important to diagnose the disease and institute disease modifying anti-rheumatic therapy as soon as possible. There is as yet no way of preventing the disease.

Lifestyle interventions of avoiding obesity, maintaining physical activity and avoiding smoking may improve outcome. Symptoms can be effectively controlled with analgesics and NSAIDs and joint damage can be reduced with disease modifying antirheumatic therapy with consequent benefits to quality of life. Biological therapies, such as anti TNF, are the latest advance that is dramatically improving the outlook for those developing RA. Rehabilitation interventions can improve and maintain function, including dynamic training. Surgery also has an important role, predominantly arthroplasty when pharmacological therapies have not adequately prevented joint damage.

Effective management of rheumatoid arthritis requires early diagnosis and treatment by recognising those with early inflammatory arthritis and for expert assessment within 6 weeks to decide about disease modifying anti-rheumatic therapy. This should be in addition to symptomatic therapy, rehabilitation and education to improve understanding of their chronic disease and to encourage self management. Such management should be provided through a multiprofessional and multidisciplinary group. People with RA need regular monitoring to ensure optimal disease management. This will reduce the risk of longterm joint damage and disability and will lessen indirect costs of RA. This approach requires systems for early diagnosis and for referral to experts, which includes education of primary care physicians to enable them to recognise synovitis. Public education is also needed to ensure early presentation to the primary care physician at the onset of symptoms.