Table 1

Standards of Care (SOC)

	SOC for people with rheumatoid arthritis (RA)	Level of agreement
SOC 1	People with symptoms of RA should have timely access to a clinician/health professional competent in making a (differential) diagnosis (6 weeks according to European League Against Rheumatism (EULAR) recommendations).	9.9
SOC 2	People with RA should be given relevant information and education about ▸ their disease ▸ its management ▸ and all aspects of living with and managing their RA, in written form and in a format suited and tailored to the individual, in a timely fashion appropriate to their needs.	9.7
SOC 3	People with RA should receive a treatment plan developed individually between them and their clinician at each visit.	9.2
SOC 4	At the start of any disease-specific treatment, people with RA should be fully educated about the expected benefits and any potential risks, and fully evaluated to assess both clinical status and safety aspects.	9.6
SOC 5	People with RA should be fully assessed for symptoms, disease activity, damage, comorbidity (including assessment for cardiovascular disease risk factors) and function at diagnosis; these assessments should also be done annually; if disease is not within target, clinical assessment should be done at least 3-monthly (all clinical variables) and possibly more frequently upon significant worsening.	9.5
SOC 6	People with RA should have rapid access to care when they experience significant worsening of the disease.	9.7
SOC 7	People with RA should be treated with a disease modifying anti-rheumatic drug (DMARD) as soon as the diagnosis is made.	9.7
SOC 8	If the target of low disease activity or remission is not achieved using a synthetic DMARD (usually being methotrexate), treatment should be revaluated at least every 3 months.	9.4
SOC 9	People with RA should be evaluated for pain, and relief of pain associated with RA should be considered.	9.3
SOC 10	People with RA who have residual joint problems despite state-of-art pharmacological (including intra-articular) and non-pharmacological therapy should be assessed by an orthopaedic surgeon within 3 months from recognition of the refractoriness of the problem, especially if there is joint damage/soft tissue problems that might likely be solved by protective or reconstructive surgery.	8.7
SOC 11	People with RA should have access to evidence-based pharmacological and non- pharmacological treatment.	9.7
SOC 12	People with RA should have access to a specialised health professional to receive assessment, advice and training in all matters related to their disease.	9.4
SOC 13	People with RA should understand the benefit of exercises and physical activity and should be advised to exercise appropriately.	9.5
SOC 14	People with RA should receive information, advice and training on joint protection and ergonomic principles as well as activity-based methods to enhance functioning in daily life and participation in social roles. They should receive information, advice and training on splints, aids, devices and other products for environmental adaptations.	9.3
SOC 15	People with RA should receive information and advice about ▸ a healthy lifestyle (such as discontinuation of all types of tobacco use, balanced use of alcohol, physical activity, healthy diet, management of sleep disturbance if necessary) ▸ prevention of accidents and injuries, ▸ support groups and patient organisations, ▸ when to think about surgery and ▸ additional treatment options provided that some people might find useful.	9.3
SOC 16	People with RA who wish to try alternative therapies that some people found symptomatically beneficial, should be informed about the limited evidence.	8.9

These SOC should be a minimum standard for all European countries and should be implemented as soon as possible, but not later than by 2020.
Of the 37 SOC, 21 were excluded because 3 or more experts rated them as not necessary in the third Delphi round. This led to the 16 SOC in the final version. 23 (89%) participants scored the level of agreement (8.7–9.9).