Treating early rheumatoid arthritis intensively: current UK practice does not reflect guidelines

Recent guidance published in the UK by the National Institute for Health and Clinical Excellence has recommended that patients with early rheumatoid arthritis (RA) are treated with combination disease-modifying anti-rheumatic drugs (DMARDs). It is unclear to what extent this reflects current UK practice. UK rheumatologists were asked to complete a web-based questionnaire asking about their treatment preferences in early RA and to indicate their attitudes to combination DMARD therapy. Although the majority was using step-up combination DMARDs, only 50% of the 258 respondents were using initial combination therapy in any patients with newly diagnosed RA despite scoring it highly for efficacy and safety. Concerns were expressed about side effects, increased monitoring requirements, and acceptability to patients. Current UK practice does not reflect the recently published guidelines. Uncertainties remain as to which patients need combination therapy and the optimal regimes to use. Further research is required to elucidate attitudes to aggressive therapy in early disease.