Developing multidisciplinary guidelines for the management of early rheumatoid arthritis.
OBJECTIVE
To develop an evidence based guideline, for the multidisciplinary management of early rheumatoid arthritis (RA).


METHODS
Recommendations were developed using both an evidence-based approach and expert opinion. The scientific committee, composed of key members of the rheumatology multidisciplinary team used a Delphi approach to evaluate topics and standard statements, which formed the basis for developing recommendations for management of RA in the first 2 years of disease. Evidence taken from literature was used to support these recommendations.


RESULTS
24 evidence based recommendations for the management of early RA, with a grade of recommendation from A to C, were developed. In addition an algorithm of care was designed to promote a clear multidisciplinary management pathway. A mechanism for audit was also identified.


CONCLUSIONS
Involvement of the multidisciplinary rheumatology team has enabled a holistic guideline to be developed for the management of patients presenting with early RA. This guideline is based around best practice that is supported by published literature. Whilst most statements in the guideline are based on strong evidence, others have been formulated by expert consensus in the absence of data and should serve as an opportunity to improve current practice through future research and audit. The development and implementation of such a guideline should improve the care of patients with early RA.
Hennell
Sheena
S
Rheumatology Department, Wirral Hospital NHS Trust, Merseyside, UK. sheenahennell@nhs.net
Luqmani
Raashid
R
D000465:Algorithms; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000473:pathology / Q000628:therapy*; D019091:Critical Pathways; D003663:Decision Trees; D003697:Delphi Technique; D019317:Evidence-Based Medicine; D006801:Humans; D008485:Medical Audit; D017410:Practice Guidelines as Topic