To What Extent is NICE Guidance on the Management of Rheumatoid Arthritis in Adults Being Implemented in Clinical Practice? A Regional Survey

Overview

Journal Clin Med (Lond)

Specialty General Medicine

Date 2013 Mar 12

PMID 23472494

Citations 5

Authors

Nicola Tugnet

Fiona Pearce

Sofia Tosounidou

Karen Obrenovic

Nicola Erb

Jonathan Packham

Ravinder Sandhu

Affiliations

Soon will be listed here.

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.

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