What are the recommended strategies for managing rheumatoid arthritis flares in a primary care setting?

Manage rheumatoid arthritis (RA) flares in primary care by liaising with the person's specialist team, especially regarding medication adjustments ¹.

Offer short-term treatment with glucocorticoids, which may include intra-articular injections for localized flares if expertise is available, or intramuscular or oral glucocorticoids as appropriate ¹.

For intra-articular injections, doses depend on joint size and severity, using agents like methylprednisolone acetate or triamcinolone acetonide ¹.

If intra-articular injection is not feasible, consider intramuscular glucocorticoids, such as methylprednisolone acetate (40 mg) or triamcinolone acetonide (40 mg), injected into the gluteal muscle ¹.

Alternatively, a short course of oral glucocorticoids can be started while awaiting specialist assessment, with tapering over 2-4 weeks depending on the course length (e.g., prednisolone 10 mg daily for 7 days, then reduce gradually) ¹.

NSAIDs should be considered at the lowest effective dose for the shortest possible time to control pain and stiffness, with regular review of risk factors and concurrent PPI use if indicated ¹.

Always exclude other causes of worsening symptoms, such as septic arthritis, especially in mono-oligo flares, and seek specialist advice for persistent or severe symptoms ¹.