RT Journal Article
SR Electronic
T1 To what extent is NICE guidance on the management of rheumatoid arthritis in adults being implemented in clinical practice? A regional survey
JF Clinical Medicine
JO Clin Med
FD Royal College of Physicians
SP 42
OP 46
DO 10.7861/clinmedicine.13-1-42
VO 13
IS 1
A1 Nicola Tugnet
A1 Fiona Pearce
A1 Sofia Tosounidou
A1 Karen Obrenovic
A1 Nicola Erb
A1 Jonathan Packham
A1 Ravinder Sandhu
YR 2013
UL http://www.rcpjournals.org/content/13/1/42.abstract
AB 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.