Clinical Practice Guidelines and Diagnostic Uncertainty in the Management of Early Rheumatoid Arthritis

Abstract

Clinical practice guidelines (CPG) are “systematically developed statements to assist practitioner and patient decisions about healthcare for specific clinical circumstances,” and are intended to improve the quality of care for individuals with a specific diagnosis by encouraging physicians to adopt more evidence-based practice1. Over the past decade, several sets of CPG for the management of rheumatoid arthritis (RA) have been developed and disseminated2–4. Many studies have demonstrated substantial gaps between disseminated CPG and clinical practice, including some in RA5,6. However, requisite to drawing meaningful conclusions about physician adherence to CPG is a more detailed understanding of the circumstances leading to perceived suboptimal healthcare practices. In an effort to explore reasons for potential nonadherence to CPG in RA, in this issue of The Journal , Benhamou and colleagues examined physician prescribing patterns for early RA7 prior to publication of 2 sets of CPG addressing prescription of first-line disease-modifying antirheumatic drugs (DMARD)2,3. Utilizing ESPOIR (French acronym for “Study and Followup of Undifferentiated Early Arthritis”), a French multicenter observational cohort study that included 813 patients with early RA between 2002 and 2005, the authors found a 58% physician adherence rate with the French Society of Rheumatologists’ STPR (French acronym for “Therapeutic strategies in RA”) working group guidelines, and a 54% adherence with … Address reprint requests to Dr. Hersh. E-mail: hersha{at}peds.ucsf.edu