title: To what extent is NICE guidance on the management of rheumatoid arthritis in adults being implemented in clinical practice? A regional survey.
abstract: Rheumatoid arthritis (RA) is a chronic disease associated with significant morbidity. The 2009 NICE guidance advises on the management of patients with RA. In this study, we undertook a survey to assess the implementation of the guidance into practice across the Midlands. In total, 19 rheumatology units participated, of which nine have designated early inflammatory arthritis clinics (EIAC). Data for 311 patients with RA attending clinics were collected during a two week period. The median time from symptom onset to first visit was four months. Of the patients, 95.6% were seen within 12 weeks of referral. Of those seen in EIAC, 75.9% had erosions documented on X-rays versus 49.4% of non-EIAC patients. In addition, 57.9% of patients were offered combination disease-modifying antirheumatic drugs (DMARD) therapy in EIAC, versus 30.4% in non-EIAC units. Monthly disease-activity scores were calculated more in patients attending EIAC than non-EIAC units (51.1% versus 25.4%). Based on our results, there is significant regional variation in implementation of the NICE guidance. In addition, patients with RA attending EIACs are more likely to receive a treat-to-target approach.
authors.affiliation: Department of Rheumatology, Royal Wolverhampton Hospitals NHS Trust. ntugnet@doctors.org.uk
authors.forename: Nicola
authors.initials: N
authors.lastname: Tugnet
authors.forename: Fiona
authors.initials: F
authors.lastname: Pearce
authors.forename: Sofia
authors.initials: S
authors.lastname: Tosounidou
authors.forename: Karen
authors.initials: K
authors.lastname: Obrenovic
authors.forename: Nicola
authors.initials: N
authors.lastname: Erb
authors.forename: Jonathan
authors.initials: J
authors.lastname: Packham
authors.forename: Ravinder
authors.initials: R
authors.lastname: Sandhu
mesh_terms: D000328:Adult; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000628:therapy*; D019468:Disease Management; D005260:Female; D006801:Humans; D008297:Male; D017410:Practice Guidelines as Topic; D011379:Prognosis; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D006113:United Kingdom
chemical_list: D018501:Antirheumatic Agents