appropriate tools are: DAS; DAS28; HAQ; known how extensively this scoring system is HAD; RA-WIS; and SDAI. The use of such used in at time of diagnosis but there is evidence tools should be regularly audited. to show that using such an approach to target treatment improves outcomes. , Section 4.3.3 7. Imaging facilities for ultrasound The diagnosis of RA can be difficult. Ultrasound Quality Ambition: NHS examination by either a clinician or scanning (USS) can detect synovitis that cannot Effective care technician with experience and expertise in be detected clinically and can be useful in the musculoskeletal ultrasound scanning of diagnostic process. EULAR has recommended inflammatory arthritis should be available if the use of ultrasound in the diagnostic process for required, preferably at the initial those patients where there is diagnostic dubiety. consultation. , Section 4.3.5 8. A concerted effort should be made to There is currently variability of access to Quality Ambition: NHS Board facilitate training in ultrasound for trainee ultrasound scanning in . Problems include a lack Effective care rheumatologists and AHPs. Recognised of skilled operators and a lack of skilled mentors. trainers in should be identified and a The use of USS is likely to be incorporated as a structured training programme based on the required skill for rheumatology trainees as advised EULAR model or postgraduate certificate by the British Society for Rheumatology (BSR). developed. , Section 4.3.5 9. Smoking cessation should be part of the Smoking increases the risk of developing RA. Quality Ambition: National / NHS management plan of all RA patients who Smoking can also reduce the effectiveness of RA Person-centred, Board smoke. treatments including anti-TNF agents and Effective care DMARDs. A recent survey of RA patients in ,
appropriate tools are: DAS; DAS28; HAQ; HAD; RA-WIS; and SDAI. The use of such tools should be regularly audited. known how extensively this scoring system is used in at time of diagnosis but there is evidence to show that using such an approach to target treatment improves outcomes. , Section 4.3.3 7. Imaging facilities for ultrasound examination by either a clinician or technician with experience and expertise in musculoskeletal ultrasound scanning of inflammatory arthritis should be available if required, preferably at the initial consultation. The diagnosis of RA can be difficult. Ultrasound scanning (USS) can detect synovitis that cannot be detected clinically and can be useful in the diagnostic process. EULAR has recommended the use of ultrasound in the diagnostic process for those patients where there is diagnostic dubiety. , Section 4.3.5 Quality Ambition: Effective care NHS 8. A concerted effort should be made to facilitate training in ultrasound for trainee rheumatologists and AHPs. Recognised trainers in should be identified and a structured training programme based on the EULAR model or postgraduate certificate developed. There is currently variability of access to ultrasound scanning in . Problems include a lack of skilled operators and a lack of skilled mentors. The use of USS is likely to be incorporated as a required skill for rheumatology trainees as advised by the British Society for Rheumatology (BSR). , Section 4.3.5 Quality Ambition: Effective care NHS Board 9. Smoking cessation should be part of the management plan of all RA patients who smoke. Smoking increases the risk of developing RA. Smoking can also reduce the effectiveness of RA treatments including anti-TNF agents and DMARDs. A recent survey of RA patients in , Quality Ambition: Person-centred, Effective care National / NHS Board
2012_09_12-PART-A_RA-HCNA_EXECUTIVE-SUMMARY-es1.docx