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Treating early rheumatoid arthritis intensively: current UK practice does not reflect guidelines
Toby Garrood1, Warren Shattles, David L Scott
1Department of Rheumatology, Guy's Hospital, Great Maze Pond, London, SE1 9RT, UK. tobygarrood@aol.com
Clinical Rheumatology
|August 5, 2010
Summary
UK rheumatologists are not fully adopting new guidelines for early rheumatoid arthritis (RA) treatment with combination disease-modifying anti-rheumatic drugs (DMARDs). Concerns about side effects and monitoring limit the use of initial combination therapy despite its perceived benefits.
Area of Science:
- Rheumatology
- Clinical Practice Guidelines
- Pharmacotherapy
Background:
- Recent UK guidance recommends initial combination disease-modifying anti-rheumatic drugs (DMARDs) for early rheumatoid arthritis (RA).
- Current UK practice regarding this recommendation remains unclear.
- Understanding rheumatologists' treatment preferences and attitudes towards combination DMARD therapy is essential.
Purpose of the Study:
- To assess current UK rheumatologists' practices in treating early rheumatoid arthritis (RA).
- To evaluate rheumatologists' attitudes towards combination disease-modifying anti-rheumatic drugs (DMARDs) in early RA.
- To compare current UK practice with recent National Institute for Health and Clinical Excellence (NICE) guidelines.
Main Methods:
- A web-based questionnaire was distributed to UK rheumatologists.
- The questionnaire collected data on treatment preferences for early RA.
- Respondents indicated their attitudes towards combination DMARD therapy.
Main Results:
- A majority of 258 respondents used "step-up" combination DMARDs.
- Only 50% of rheumatologists initiated combination therapy for newly diagnosed RA patients.
- Concerns regarding side effects, monitoring, and patient acceptability were cited as barriers.
Conclusions:
- Current UK practice for early RA treatment does not fully align with recent NICE guidelines.
- Uncertainties persist regarding patient selection and optimal combination therapy regimens.
- Further research is needed to address attitudes towards aggressive early RA treatment strategies.
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