title: Regional and temporal variation in the treatment of rheumatoid arthritis across the UK: a descriptive register-based cohort study.
abstract: OBJECTIVE
  To describe current disease-modifying antirheumatic drugs (DMARDs) prescription in rheumatoid arthritis (RA) with reference to best practice and to identify temporal and regional trends in the UK.
  
  
  METHODS
  Descriptive, register-based cohort study.
  
  
  METHODS
  Permanently registered patients aged ≥18 years with a recorded diagnosis of RA between 1 January 1995 and 31 March 2010 and matched controls. Participants with RA were identified through screening of all patients in the General Practice Research Database (GPRD) with a clinical or referral record for RA and at least 1 day of follow-up.
  
  
  METHODS
  639 general practices in the UK supplying data to the GPRD.
  
  
  METHODS
  Medication prescribing between 3 and 12 months of RA diagnosis by region and time period (1995-1999, 2000-2005 and 2006-April 2010).
  
  
  RESULTS
  Of the 35 911 patients in the full RA cohort, 15 259 patients (42%) had incident RA. Analysis of prescribing in incident RA patients demonstrated that between 1995 (baseline) and 2010 there was a substantial increase in DMARD, and specifically methotrexate, prescribing across all regions with a less marked increase in combination DMARD prescribing. Taking 12-month prescribing as a snapshot: DMARD prescribing was 19-49% at baseline increasing to 45-74% by 2006-April 2010; methotrexate prescribing was 4-16% at baseline increasing to 32-60%; combination DMARD prescribing was 0-8% at baseline increasing to 3-17%. However, there was marked regional variation in the proportion of RA patients receiving DMARD regardless of time period.
  
  
  CONCLUSIONS
  There has been a substantial increase in prescribing of DMARDs for RA since 1995; however, regional variation persists across the UK with relative undertreatment, according to established best practice. Improved implementation of evidence-based best clinical practice to facilitate removal of treatment variation is warranted. This may occur as a result of the implementation of published national guidance.
authors.affiliation: Department of Rheumatology,  University Hospital Southampton NHS Foundation Trust, Southampton,  UK.
authors.forename: Christopher John
authors.initials: CJ
authors.lastname: Edwards
authors.forename: Jennifer
authors.initials: J
authors.lastname: Campbell
authors.forename: Tjeerd
authors.initials: T
authors.lastname: van Staa
authors.forename: Nigel K
authors.initials: NK
authors.lastname: Arden