• Elena Nikiphorou, James Galloway, Piet van Riel, Yusuf Yazici, Glenn Haugeberg, Andrew Ostor, Feride Gogus, Markku Kauppi, Tuulikki Sokka, and QUEST-RA.
• Department of Rheumatology, Whittington Hospital, London, UK; and Jyväskylä Central Hospital, Rheumatology Unit, Jyväskylä, Finland.
• Clin Exp Rheumatol. 2017 May 1; 35 (3): 477-483.

ObjectivesTo explore patterns of real-world early RA (ERA) care across countries.MethodsAn online survey was disseminated to practising rheumatologists across Europe and the US, also made accessible on social media between April and May 2015. Survey questions (n=38) assessed the structure and setting of ERA clinics, times to diagnosis and treatment, patient monitoring, guideline use and data recording.ResultsA total of 212 rheumatologists from 39 countries (76% European) completed the survey. 62% had an ERA clinic based at a university hospital. Patient referral to rheumatology was mainly (78%) via primary care; 44% had an agreed ERA local referral pathway, 15% a national pathway. Only 16% had dedicated ERA clinics, the majority being practitioners in Northern Europe with access to a local or national referral pathway. Data for research were collected by 42%. Treatment guidelines were followed by the majority, especially rheumatologists practising in Europe. Variations existed in the use of initial DMARDs with treatment decisions reported to be influenced by international/national guidelines in 71%/61%. No significant relationship between country gross national income and the availability of ERA clinics was seen.ConclusionsThis study provides comparative benchmark information regarding the global provision of ERA care. Substantial variations exist in referral and early assessment pathways with guidelines having a most apparent impact in Northern Europe. Provision of an ERA service does not appear to be constrained by cost, with conceptual factors, e.g. clinician engagement, perhaps playing a role. These initial insights could potentially help harmonise ERA management across countries.

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