PT  - JOURNAL ARTICLE
AU  - Mathilde Benhamou
AU  - Nathalie Rincheval
AU  - Carine Roy
AU  - Violaine Foltz
AU  - Sylvie Rozenberg
AU  - Jean Sibilia
AU  - Thierry Schaeverbeke
AU  - Pierre Bourgeois
AU  - Philippe Ravaud
AU  - Bruno Fautrel
TI  - The Gap Between Practice and Guidelines in the Choice of First-line Disease Modifying Antirheumatic Drug in Early Rheumatoid Arthritis: Results from the ESPOIR Cohort
AID  - 10.3899/jrheum.080762
DP  - 2009 Mar 15
TA  - The Journal of Rheumatology
PG  - jrheum.080762
4099  - http://www.jrheum.org/content/early/2009/03/13/jrheum.080762.short
4100  - http://www.jrheum.org/content/early/2009/03/13/jrheum.080762.full
AB  - Objective To compare rheumatologists’ prescription for first disease modifying antirheumatic drug (DMARD) in early rheumatoid arthritis (RA) in real-life settings with 2 clinical practice guidelines (CPG), the French Society of Rheumatology/STPR 2004 and EULAR/ESCISIT 2007, and thus assess the gap between practices and guidelines. Methods ESPOIR was a French multicenter cohort study of 813 patients with early arthritis between 2002 and 2005. “Definite” and “probable” RA were defined according to ACR criteria and the level of diagnostic certainty. The objectives were to assess conformity between the observed first-line DMARD prescribed for those patients and the DMARD recommended in the guidelines; and to conduct a mail survey of patients’ usual rheumatologists to investigate the reasons for their nonconformity with guidelines. Results In total 627 patients with definite or probable RA were identified. Conformity rates were 58% for STPR guidelines and 54% for EULAR guidelines. At 6 months, 83 (34%) patients with early RA did not receive any DMARD. Main determinants associated with conformity to guidelines were disease activity and presence of severity-predictive factors. The main reason leading to a discrepancy between guidelines and daily practice appeared to be diagnostic uncertainty, i.e., the difficulty to reliably assess RA diagnosis as early as the first visits to the rheumatologist. Conclusion There is a substantial gap between CPG and rheumatologists’ daily practice concerning the first DMARD to prescribe in early RA. This is explained mainly by diagnostic uncertainty. More attention should be paid in future guidelines to the diagnostic difficulties of early RA.