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GP management of stable established rheumatoid arthritis is as effective and significantly more cost-effective than aggressive hospital care, a new NHS trial concludes.

The Health Technology Assessment found aggressive management by rheumatologists had no benefits over 'symptomatic' treatment in primary care with visits from specialist nurses.

The University of Manchester trial of 399 patients found no significant difference between treatment arms, although aggressive treatment brought a slight improvement in disease activity.

But economic and sensitivity analysis indicated that symptomatic treatment was likely to be more cost-effective in 58 to 90 per cent of cases.

'Patients in the symptomatic arm were able to initiate changes in therapy when their symptoms deteriorated without frequent hospital assessment,' the researchers concluded.

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