Skip to main content

Advertisement

SpringerLink
Log in

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

  • Brief Report
  • Published:
Clinical Rheumatology Aims and scope Submit manuscript

Abstract

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

References

  1. National Institiute for Health and Clinical Excellence (2009) Rheumatoid arthritis: national clincal guideline for management and treatment in adults. www.nice.org.uk

  2. McCarty DJ (1981) Treating intractable rheumatoid arthritis. N Engl J Med 305:1009–1011

    Article  CAS  PubMed  Google Scholar 

  3. Boers M, Verhoeven AC, Markusse HM, van de Laar MA, Westhovens R, van Denderen JC, van Zeben D, Dijkmans BA, Peeters AJ, Jacobs P, van den Brink HR, Schouten HJ, van der Heijde DM, Boonen A, van der LS (1997) Randomised comparison of combined step-down prednisolone, methotrexate and sulphasalazine with sulphasalazine alone in early rheumatoid arthritis. Lancet 350:309–318

    Article  CAS  PubMed  Google Scholar 

  4. O'Dell JR, Haire CE, Erikson N, Drymalski W, Palmer W, Eckhoff PJ, Garwood V, Maloley P, Klassen LW, Wees S, Klein H, Moore GF (1996) Treatment of rheumatoid arthritis with methotrexate alone, sulfasalazine and hydroxychloroquine, or a combination of all three medications. N Engl J Med 334:1287–1291

    Article  PubMed  Google Scholar 

  5. Mottonen T, Hannonen P, Leirisalo-Repo M, Nissila M, Kautiainen H, Korpela M, Laasonen L, Julkunen H, Luukkainen R, Vuori K, Paimela L, Blafield H, Hakala M, Ilva K, Yli-Kerttula U, Puolakka K, Jarvinen P, Hakola M, Piirainen H, Ahonen J, Palvimaki I, Forsberg S, Koota K, Friman C (1999) Comparison of combination therapy with single-drug therapy in early rheumatoid arthritis: a randomised trial. FIN-RACo trial group. Lancet 353:1568–1573

    Article  CAS  PubMed  Google Scholar 

  6. Combe B, Landewe R, Lukas C, Bolosiu HD, Breedveld F, Dougados M, Emery P, Ferraccioli G, Hazes JM, Klareskog L, Machold K, Martin-Mola E, Nielsen H, Silman A, Smolen J, Yazici H (2007) EULAR recommendations for the management of early arthritis: report of a task force of the European Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT). Ann Rheum Dis 66:34–45

    Article  CAS  PubMed  Google Scholar 

  7. Luqmani R, Hennell S, Estrach C, Birrell F, Bosworth A, Davenport G, Fokke C, Goodson N, Jeffreson P, Lamb E, Mohammed R, Oliver S, Stableford Z, Walsh D, Washbrook C, Webb F (2006) British Society for Rheumatology and british health professionals in Rheumatology guideline for the management of rheumatoid arthritis (the first two years). Rheumatology (Oxford) 45:1167–1169

    Article  CAS  Google Scholar 

  8. van der Kooij SM, de Vries-Bouwstra JK, Goekoop-Ruiterman YP, van Zeben D, Kerstens PJ, Gerards AH, van Groenendael JH, Hazes JM, Breedveld FC, Allaart CF, Dijkmans BA (2007) Limited efficacy of conventional DMARDs after initial methotrexate failure in patients with recent onset rheumatoid arthritis treated according to the disease activity score. Ann Rheum Dis 66:1356–1362

    Article  PubMed  Google Scholar 

  9. Choy EH, Smith C, Dore CJ, Scott DL (2005) A meta-analysis of the efficacy and toxicity of combining disease-modifying anti-rheumatic drugs in rheumatoid arthritis based on patient withdrawal. Rheumatology (Oxford) 44:1414–1421

    Article  CAS  Google Scholar 

  10. Saag KG, Teng GG, Patkar NM, Anuntiyo J, Finney C, Curtis JR, Paulus HE, Mudano A, Pisu M, Elkins-Melton M, Outman R, Allison JJ, Suarez AM, Bridges SL Jr, Chatham WW, Hochberg M, MacLean C, Mikuls T, Moreland LW, O'Dell J, Turkiewicz AM, Furst DE (2008) American College of Rheumatology 2008 recommendations for the use of nonbiologic and biologic disease-modifying antirheumatic drugs in rheumatoid arthritis. Arthritis Rheum 59:762–784

    Article  CAS  PubMed  Google Scholar 

  11. Jobanputra P, Wilson J, Douglas K, Burls A (2004) A survey of British rheumatologists' DMARD preferences for rheumatoid arthritis. Rheumatology (Oxford) 43:206–210

    Article  CAS  Google Scholar 

  12. Mikuls TR, O'Dell J (2000) The changing face of rheumatoid arthritis therapy: results of serial surveys. Arthritis Rheum 43:464–465

    Article  CAS  PubMed  Google Scholar 

  13. van Tuyl LH, Plass AM, Lems WF, Voskuyl AE, Dijkmans BA, Boers M (2007) Why are Dutch rheumatologists reluctant to use the COBRA treatment strategy in early rheumatoid arthritis? Ann Rheum Dis 66:974–976

    Article  PubMed  Google Scholar 

  14. van Tuyl LH, Plass AM, Lems WF, Voskuyl AE, Kerstens PJ, Dijkmans BA, Boers M (2008) Discordant perspectives of rheumatologists and patients on COBRA combination therapy in rheumatoid arthritis. Rheumatology (Oxford) 47:1571–1576

    Article  Google Scholar 

  15. Goekoop-Ruiterman YP, de Vries-Bouwstra JK, Allaart CF, Kerstens PJ, Grillet BA, de Jager MH, Han KH, Speyer I, van der Lubbe PA, Seys PE, Breedveld FC, Dijkmans BA (2007) Patient preferences for treatment: report from a randomised comparison of treatment strategies in early rheumatoid arthritis (BeSt trial). Ann Rheum Dis 66:1227–1232

    Article  PubMed  Google Scholar 

  16. Kirwan JR, Chaput de Saintonge DM, Joyce CR, Holmes J, Currey HL (1986) Inability of rheumatologists to describe their true policies for assessing rheumatoid arthritis. Ann Rheum Dis 45:156–161

    Article  CAS  PubMed  Google Scholar 

  17. Kiely P, Williams R, Walsh D, Young A (2009) Contemporary patterns of care and disease activity outcome in early rheumatoid arthritis: the ERAN cohort. Rheumatology (Oxford) 48:57–60

    Article  CAS  Google Scholar 

Download references

Acknowledgements

The authors would like to thank all the rheumatologists who completed the survey.

Disclosures

None

Author information

Authors and Affiliations

  1. Department of Rheumatology, Guy’s Hospital, 4th Floor Tower Wing, Great Maze Pond, London, SE1 9RT, UK

    Toby Garrood

  2. Department of Rheumatology, East Surrey Hospital, Canada Avenue, Redhill, RH1 5RH, UK

    Warren Shattles

  3. Academic Department of Rheumatology, Kings College London, Weston Education Centre, Cutcombe Road, London, SE5 9RJ, UK

    David L. Scott

Authors
  1. Toby Garrood
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Warren Shattles
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. David L. Scott
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Toby Garrood.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Garrood, T., Shattles, W. & Scott, D.L. Treating early rheumatoid arthritis intensively: current UK practice does not reflect guidelines. Clin Rheumatol 30, 103–106 (2011). https://doi.org/10.1007/s10067-010-1541-0

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10067-010-1541-0

Keywords

Search

Navigation