<<forEachTiddler  where 'tiddler.tags.contains(context.inTiddler.title)'
sortBy 
        tiddler.title
    ascending 
write '"*[["+tiddler.title+"]]\n"'>>
<<tiddler AutoRefresh with: force>>

NICE guidelines 2009
evidence of joint inflammation  - start combination of disease-modifying drugs (DMARD) as soon as possible
Initially Methotrexate, one other DMARD and short term steroids
Also - analgesia, physiotherapy and surgery.

''DMARDs''
    methotrexate most widely used DMARD - Monitor FBC & LFTs - risk of myelosuppression and liver cirrhosis also pneumonitis
    sulfasalazine
    leflunomide
    hydroxychloroquine

''TNF-inhibitors''
    use if inadequate response to at least two DMARDs including methotrexate
    etanercept: recombinant human protein, acts as a decoy receptor for TNF-α, subcutaneous administration, can cause demyelination, risks include reactivation of tuberculosis
    infliximab: monoclonal antibody, binds to TNF-α and prevents it from binding with TNF receptors, intravenous administration, risks include reactivation of tuberculosis
    adalimumab: monoclonal antibody, subcutaneous administration

''Rituximab''
    anti-CD20 monoclonal antibody, results in B-cell depletion
    two 1g intravenous infusions are given two weeks apart
    infusion reactions are common

''Abatacept''
    fusion protein that modulates a key signal required for activation of T lymphocytes
    leads to decreased T-cell proliferation and cytokine production
    given as an infusion
    not currently recommend by NICE