Clinical Audit of Rheumatoid Arthritis Management: Adherence to NICE and EULAR Guidelines.

Abstract

Objective: To assess adherence to National Institute for Health and Care Excellence; Guideline number 100 (NICE NG100) and European Alliance of Associations for Rheumatology (EULAR 2022) guidelines across five domains: initia-tion of Disease-Modifying Antirheumatic Drugs (DMARDs) at an early stage, selection of appropriate first-line therapy, implementation of treat-to-target monitoring, timely escalation to biologics in non-responders, and comprehensive pre-biologic evaluation including infectious disease screening and vaccination.
Methodology: A retrospective audit of 153 recently diagnosed rheumatoid arthritis patients was conducted. Data col-lected included demographics, diagnostic intervals, DMARD initiation times, first-line therapy choice, DAS28-ESR scores, remission rates, biologic escalation, and pre-biologic screening compliance.
Results: The cohort comprised 121 females (79.1%) and 32 males (20.9%), with diagnostic intervals of 7–24 days. All patients initiated DMARDs within 6 weeks of diagnosis. First-line therapy included methotrexate monotherapy (n=128, 83.7%), methotrexate plus hydroxychloroquine (n=6,3.9%), and sulfasalazine plus hydroxychloroquine (n=19, 12.4%), Remission was achieved in 101(66.0%) patients with first-line conventional synthetic DMARDs within an average of 10 weeks. The remaining (n=52, 34.0%), were escalated to biologics after 12 weeks; mean DAS28-ESR decreased from 4.2±1.1 pre-biologic to 1.8±0.8 post-biologic at 3 months. Pre-biologic infectious disease screening (hepatitis B, hepati-tis C, tuberculosis, lipid profile) showed 100% compliance. However, no patients received pneumococcal, influenza, or varicella vaccines before biologic initiation, and COVID-19 vaccination status was undocumented.
Conclusion: This audit demonstrates strong adherence to core guideline recommendations, including: Early DMARD initiation, Methotrexate-based first-line therapy, Implementation of treat-to-target strategies, Timely escalation to biologic therapy in non-responders. Compliance with infectious disease screening was satisfactory. However, a significant gap was identified in pre-biologic vaccination, underscoring the urgent need for standardized vaccination protocols prior to initiating biologic therapy.
Keywords: Rheumatoid arthritis, clinical audit, DMARD therapy, treat-to-target, vaccination compliance.