title: Can the publication of guidelines change the management of early rheumatoid arthritis? An interrupted time series analysis from the United Kingdom.
abstract: OBJECTIVE
  To assess whether publication of national treatment guidelines improved the management of early RA in the UK.
  
  
  METHODS
  Incident diagnoses of RA in persons aged over 18 years from 1995 to 2010 were identified from the Clinical Practice Research Datalink. Using a natural experimental study design, interrupted time series analysis was used to assess whether trends in the proportion of patients receiving DMARDs, within 3 and 12 months of diagnosis, changed following publication of British Society for Rheumatology guidelines in 2006.
  
  
  RESULTS
  Between 1995 and 2010, 11 772 incident cases of RA were identified. There was a progressive increase in the proportion of patients prescribed any DMARD within 12 months from 43.3% in 1995 to 78.5% in 2010. After publication of the British Society for Rheumatology guidelines, the proportion of patients prescribed any DMARD within 12 months increased by 4.2% (P = 0.053). Prior to the guidance, prescribing was increasing by 1.64% per year, compared with 3.55% per year after publication (P < 0.001).
  
  
  CONCLUSIONS
  Guidelines published by a national body can improve the proportion of patients receiving DMARD treatment in the first year after diagnosis of RA.
authors.affiliation: Oxford NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, andrew.Judge@ndorms.ox.ac.uk.
authors.forename: Andrew
authors.initials: A
authors.lastname: Judge
authors.affiliation: Oxford NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford.
authors.forename: Gemma
authors.initials: G
authors.lastname: Wallace
authors.affiliation: Oxford NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital.
authors.forename: Dani
authors.initials: D
authors.lastname: Prieto-Alhambra
authors.affiliation: Oxford NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital.
authors.forename: Nigel K
authors.initials: NK
authors.lastname: Arden
authors.affiliation: Oxford NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, Department of Rheumatology, University Hospital Southampton NHS Foundation Trust and NIHR Wellcome Trust Clinical Research Facility, University of Southampton, Southampton, UK.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Edwards
mesh_terms: D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000453:epidemiology; D016208:Databases, Factual; D019468:Disease Management; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D004363:Drug Utilization / Q000706:statistics & numerical data / Q000639:trends; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006801:Humans; D065186:Interrupted Time Series Analysis; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data / Q000639:trends; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D018501:Antirheumatic Agents
keywords: DMARDs; epidemiology; guidelines; natural experiment; rheumatoid arthritis