title: [Is the guideline, "Management of early rheumatoid arthritis," being followed in a rheumatism center?].
abstract: BACKGROUND
  There are indications that the influence of external guidelines on the quality of health care is limited and they are little or not at all used in clinical practice. It was the aim of this study to examine how and to what extent the external S3 guideline "Management of Early Rheumatoid Arthritis" was applied in a rheumatism center.
  
  
  METHODS
  In accordance with the data of all rheumatoid arthritis patients, who were treated November 2007, an investigation was carried out on the degree of application and realization of the S3 guideline which had been changed into an internal guideline. The primary objective was the Disease Modifying Anti-Rheumatic Drug (DMARD) therapy; secondary objectives were the administration of methotrexate with folic acid, the administration of glucocorticoids with calcium and vitamin D; and NSAR monotherapy.
  
  
  RESULTS
  94.6 % of the patients were given a therapy of basis drugs (DMARDs). 82.5 % of the methotrexate patients additionally received folic acid. 65.9 % of the patients received, in addition to glucocorticoids, calcium and vitamin D. In 99.1 % of the cases NSAR monotherapy was instituted.
  
  
  CONCLUSIONS
  The high degree of application does not correspond with the results of previous studies on guideline compliance with external guidelines. A possible explanation of this may be the change made of the external guideline to a guideline within the hospital.
authors.affiliation: Universitätsklinikum Jena, Erlanger Allee 101, 07747 Jena. Michael.Hartmann@med.uni-jena.de
authors.forename: M
authors.initials: M
authors.lastname: Hartmann
authors.forename: C
authors.initials: C
authors.lastname: Gundermann
authors.forename: A
authors.initials: A
authors.lastname: Richter
authors.forename: T
authors.initials: T
authors.lastname: Eidner
authors.forename: G
authors.initials: G
authors.lastname: Hein
mesh_terms: D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D002118:Calcium / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005492:Folic Acid / Q000627:therapeutic use; D005858:Germany; D005938:Glucocorticoids / Q000627:therapeutic use; D019983:Guideline Adherence / Q000592:standards*; D006782:Hospitals, Special; D006801:Humans; D008727:Methotrexate / Q000627:therapeutic use; D012219:Rheumatology; D014803:Vitamin B Complex / Q000627:therapeutic use; D014807:Vitamin D / Q000627:therapeutic use; D014815:Vitamins / Q000627:therapeutic use
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D018501:Antirheumatic Agents; D005938:Glucocorticoids; D014815:Vitamins; D014803:Vitamin B Complex; D014807:Vitamin D; D005492:Folic Acid; D002118:Calcium; D008727:Methotrexate