Shaping better health
REMEDY : BNSSG referral pathways & Joint Formulary

BNSSG Paediatric Joint Formulary

10.1 Arthritis

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10.1 Arthritis

First line drugs Second line drugs Specialist drugs Secondary care drugs

 

BNF C Juvenile idiopathic arthritis

BNF C Rheumatic disease, suppressing 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)

Tocilizumab (TLS Red)

  • According to NICE TA238 Tocilizumab for the treatment of systemic juvenile idiopathic arthritis
  • According to 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)

Ustekinumab (TLS Red)

  • According to NICE guidance TA195 Rheumatoid Arthritis - drugs for treatment after failure of a TNF inhibitor
  • According to NICE guidance TA280 Abatacept for treating rheumatoid arthritis after the failure of conventional disease-modifying anti-rheumatic drugs (rapid review of technology appraisal guidance 234)
  • According to NICE guidance 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)

Etanercept (TLS Red)

Golimumab (TLS Red)

  • According to NICE TA220 (psoriatic arthritis)
  • According to NICE TA225 (rheumatoid arthritis, after the failure of previous anti-rheumatic drugs)
  • According to NICE TA233 (ankylosing spondylitis)

Infliximab (TLS Red)

Rituximab (TLS Red)

  • See NICE guidance 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 guidance 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 (oral) 2.5mg tablets only - 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).

Methotrexate (parenteral) - weekly dose (TLS Red)

Mycophenolate (oral) (TLS Red)

  • Rheumatology uses  - unlicensed indication