title: When rheumatologists report that they agree with a guideline, does this mean that they practise the guideline in clinical practice? Results of the International Recommendation Implementation Study (IRIS).
abstract: BACKGROUND
  The European League Against Rheumatism (EULAR) recommendations for the management of rheumatoid arthritis (RA) and the treat-to-target (T2T) principles have been developed in order to improve the treatment outcome of patients with RA, and have received broad attention. It is not clear, though, whether these recommendations are indeed followed up in clinical practice.
  
  
  OBJECTIVE
  To investigate if rheumatologists that report to agree with existing guidelines indeed follow them up in clinical practice.
  
  
  METHODS
  The International Recommendation Implementation Study (IRIS) included 132 participating rheumatologists from 14 countries. Participating rheumatologists received a questionnaire measuring their awareness/commitment with the EULAR/T2T recommendations and followed a dedicated educational programme. Subsequently, they were asked to enrol 5-10 patients with new-onset RA in the online IRIS database and monitor disease activity and treatment for a period of 1-2 years. Four recommendations (3 from the EULAR recommendations and one from the T2T recommendations) were selected on the basis of testability, and analysed with regard to compliance by participating rheumatologists.
  
  
  RESULTS
  In total, 72 of the 132 participating rheumatologists contributed 378 patients to the database. Of these participants, 70 (98%) agreed upfront with the recommendation that disease-modifying antirheumatic drug (DMARD) therapy should be started as soon as possible after diagnosis in every patient; 69 (96%) of the rheumatologists agreed with the recommendation that methotrexate (MTX) should be part of the first treatment strategy. When measuring the actual performance, it was found that the recommendation on early DMARD start was met in 253 (67%) of the recorded patients, and the recommendation on MTX in 225 (60%) of the recorded patients. Of the participants, 60 (83%) agreed that composite measures should be recorded regularly, but only in 134(54%) of the patients were composite scores actually recorded in ≥50% of patient visits.
  
  
  CONCLUSIONS
  Reporting to be compliant with EULAR recommendations and T2T principles, even after dedicated education does not mean they actually comply with it in clinical practice.
authors.affiliation: Department of Rheumatology , Leiden University Medical Center , Leiden , The Netherlands.
authors.forename: Emilia
authors.initials: E
authors.lastname: Gvozdenović
authors.affiliation: Department of Rheumatology , Leiden University Medical Center , Leiden , The Netherlands.
authors.forename: Cornelia F
authors.initials: CF
authors.lastname: Allaart
authors.affiliation: Department of Rheumatology , Leiden University Medical Center , Leiden , The Netherlands.
authors.forename: Désirée
authors.initials: D
authors.lastname: van der Heijde
authors.affiliation: Division of Rheumatology , on behalf of GISEA, Catholic University of the Sacred Heart , Rome , Italy.
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Ferraccioli
authors.affiliation: Division of Rheumatology , Medical University of Vienna , Vienna , Austria.
authors.forename: Josef S
authors.initials: JS
authors.lastname: Smolen
authors.affiliation: Department of Rheumatology , Leiden University Medical Center , Leiden , The Netherlands.
authors.forename: Tom W J
authors.initials: TW
authors.lastname: Huizinga
authors.affiliation: Rheumatology Department , Academic Medical Center, Amsterdam & Atrium Medical Center , Heerlen , The Netherlands.
authors.forename: Robert
authors.initials: R
authors.lastname: Landewé
keywords: DMARDs (biologic); DMARDs (synthetic); Disease Activity; Rheumatoid Arthritis; Treatment