title: The spectrum of early rheumatoid arthritis practice across the globe: results from a multinational cross sectional survey.
abstract: OBJECTIVE
  To explore patterns of real-world early RA (ERA) care across countries.
  
  
  METHODS
  An online survey was disseminated to practising rheumatologists across Europe and the US, also made accessible on social media between April and May 2015. Survey questions (n=38) assessed the structure and setting of ERA clinics, times to diagnosis and treatment, patient monitoring, guideline use and data recording.
  
  
  RESULTS
  A total of 212 rheumatologists from 39 countries (76% European) completed the survey. 62% had an ERA clinic based at a university hospital. Patient referral to rheumatology was mainly (78%) via primary care; 44% had an agreed ERA local referral pathway, 15% a national pathway. Only 16% had dedicated ERA clinics, the majority being practitioners in Northern Europe with access to a local or national referral pathway. Data for research were collected by 42%. Treatment guidelines were followed by the majority, especially rheumatologists practising in Europe. Variations existed in the use of initial DMARDs with treatment decisions reported to be influenced by international/national guidelines in 71%/61%. No significant relationship between country gross national income and the availability of ERA clinics was seen.
  
  
  CONCLUSIONS
  This study provides comparative benchmark information regarding the global provision of ERA care. Substantial variations exist in referral and early assessment pathways with guidelines having a most apparent impact in Northern Europe. Provision of an ERA service does not appear to be constrained by cost, with conceptual factors, e.g. clinician engagement, perhaps playing a role. These initial insights could potentially help harmonise ERA management across countries.
authors.affiliation: Department of Rheumatology, Whittington Hospital, London, UK; and Jyväskylä Central Hospital, Rheumatology Unit, Jyväskylä, Finland.
authors.forename: Elena
authors.initials: E
authors.lastname: Nikiphorou
authors.affiliation: King's College London, Academic Rheumatology Department, London, UK.
authors.forename: James
authors.initials: J
authors.lastname: Galloway
authors.affiliation: Department of Rheumatology, Bernhoven, Uden, The Netherlands.
authors.forename: Piet
authors.initials: P
authors.lastname: van Riel
authors.affiliation: NYU Hospital for Joint Diseases, New York, NY, USA.
authors.forename: Yusuf
authors.initials: Y
authors.lastname: Yazici
authors.affiliation: Department of Rheumatology, Martina Hansens Hospital, Bærum, Norway.
authors.forename: Glenn
authors.initials: G
authors.lastname: Haugeberg
authors.affiliation: Department of Rheumatology, Addenbrookes Hospital, Cambridge, UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Ostor
authors.affiliation: Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Gazi University, Faculty of Medicine, Ankara, Turkey.
authors.forename: Feride
authors.initials: F
authors.lastname: Gogus
authors.affiliation: Medical School, Tampere University, Tampere, Finland.
authors.forename: Markku
authors.initials: M
authors.lastname: Kauppi
authors.affiliation: Jyväskylä Central Hospital, Rheumatology Unit, Jyväskylä, Finland. tuulikki.sokka-isler@ksshp.fi.
authors.forename: Tuulikki
authors.initials: T
authors.lastname: Sokka
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D001688:Biological Products / Q000627:therapeutic use; D019091:Critical Pathways / Q000639:trends; D003430:Cross-Sectional Studies; D019033:Delivery of Health Care, Integrated / Q000639:trends*; D005060:Europe / Q000453:epidemiology; D019983:Guideline Adherence; D019538:Health Care Surveys; D054625:Healthcare Disparities / Q000639:trends*; D006801:Humans; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000639:trends*; D012017:Referral and Consultation / Q000639:trends; D000072140:Rheumatologists / Q000639:trends*; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
chemical_list: D000305:Adrenal Cortex Hormones; D018501:Antirheumatic Agents; D001688:Biological Products