Management of early rheumatoid arthritis: Isthe guideline being followed in a rheumatism center?

BACKGROUND: There are indications thatthe influence of external guidelines on the quality of health careis limited and they are little or not at all used in clinical practice.It was the aim of this study to examine how and to what extent theexternal S3 guideline "Management of Early Rheumatoid Arthritis” wasapplied in a rheumatism center. MATERIALS AND METHODS: In accordancewith the data of all rheumatoid arthritis patients, who were treatedNovember 2007, an investigation was carried out on the degree ofapplication and realization of the S3 guideline which had been changedinto an internal guideline. The primary objective was the DiseaseModifying Anti-Rheumatic Drug (DMARD) therapy; secondary objectiveswere the administration of methotrexate with folic acid, the administrationof glucocorticoids with calcium and vitamin D; and NSAR monotherapy. RESULTS: 94.6 % ofthe patients were given a therapy of basis drugs (DMARDs). 82.5 % ofthe methotrexate patients additionally received folic acid. 65.9 % ofthe patients received, in addition to glucocorticoids, calcium andvitamin D. In 99.1 % of the cases NSAR monotherapywas instituted. CONCLUSION: The high degree of applicationdoes not correspond with the results of previous studies on guidelinecompliance with external guidelines. A possible explanation of thismay be the change made of the external guideline to a guidelinewithin the hospital.