Background National Institute of Clinical Excellence Clinical Guideline 79 (NICE CG79) in the UK states that newly diagnosed RA patients should be offered combination DMARDs within 3 months of persistent symptom onset and be monitored using a composite score monthly until their disease is under control. We instigated a rapid access early inflammatory arthritis clinic followed by monthly review clinic in March 2010 for patients with new RA. In the UK patients with RA can only be treated with biologic therapy if they have severe disease activity, however, the British Society of Rheumatology (BSR) has published guidelines supporting the biologic treatment of patients with moderate disease activity alongwith 3 swollen/tender joints. The monthly review clinics are carried out by Rheumatology Nurse Practitioners.
Objectives An audit against the NICE CG79 was undertaken to ensure compliance and to elicit the number of patients who continue to have moderate disease activity with 3 or more swollen/ tender joints.
Methods All patients with RA of under 2 years duration attending the monthly review clinic were included in the audit. The NICE CG79 audit tool was used to set the standards and criteria. All patients were deemed diagnosed with RA according to the American College of Rheumatology criteria 2010. Disease Activity Scores (DAS28) were used to set the level of disease activity.
Results 106 patients with RA had been monitored through the monthly review clinic. Demographics were M:F 1:1.3, mean age 60 years, Rh Factor +ve 62%and anti CCP +ve 63%. Average age of onset 59.8, average time from symptom onset to GP appointment 11 weeks. All patients had been offered written information about their disease and medication, 95% patients had their DAS28 measured 4-6/52 until disease stable. 90% patients were commenced on either methotrexate monotherapy or combination with plaquenil according to protocol. At 2 years 57% patients were on combination DMARDs, 41% patients were on methotrexate (oral or s/c) monotherapy due to good disease control. 6 patients were on biologic therapy. 8 patients met the BSR guideline with moderate disease activity and 3 swollen/tender joints. All patients with high disease activity at 1 year, 18 months and 2 years were either on, had been offered or were contra-indicated for biologic therapy.
Conclusions Data is limited to 83 patients at 2 years due to lack of disease duration for our cohort of patients however, 73% patients were in remission or low disease activity. Only 6 patients met NICE guidelines for biologic therapy due to contraindications and disease activity. During the 2 year period only 8 patients met the BSR guidelines for treatment with biologic therapy. Introduction of this tight disease control monthly review clinic for early RA by the Rheumatology Practitioners was highly effective, enabled tight control for the majority of patients whilst not increasing biologic therapy prescribing and at no extra staffing costs.
Disclosure of Interest None Declared