ArticleRMD open2016
When rheumatologists report that they agree with a guideline, does this mean that they practise the guideline in clinical practice? Results of the International Recommendation Implementation Study (IRIS).
Article in RMD open, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 22 papers, 2 of them syntheses that pooled it.
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Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
22 citing papers in PubMed, 2 syntheses or guidelines pooled it, 53 citations in OpenAlex.
- Barriers to, Facilitators of, and Interventions to Support Treat-to-Target Implementation in Rheumatoid Arthritis: A Systematic Review.Arthritis care & research · 2024Pooled it
- Treating axial spondyloarthritis and peripheral spondyloarthritis, especially psoriatic arthritis, to target: 2017 update of recommendations by an international task force.Annals of the rheumatic diseases · 2018Guideline
- Management of Rheumatoid Arthritis With a Digital Health Application: A Multicenter, Pragmatic Randomized Clinical Trial.JAMA network open · 2023Trial
- Navigating the gap: the challenge of applying treat-to-target in routine lupus care-a national perspective.Lupus science & medicine · 2026Article
- Treat-to-target in Behçet syndrome.Nature reviews. Rheumatology · 2026Review
- Barriers and facilitators to treat-to-target in axial spondyloarthritis in clinical practice: a mixed methods study.Rheumatology international · 2025Article
- Challenges in implementing treat-to-target in rheumatoid arthritis: a perspective from Brazilian rheumatologists.Advances in rheumatology (London, England) · 2024Article
- A prospective survey on therapeutic inertia in psoriatic arthritis (OPTI'PsA).Rheumatology (Oxford, England) · 2024Article
- Attitudes and practices in the laboratory monitoring of conventional synthetic disease modifying anti-rheumatic drugs by rheumatologists and rheumatology trainees.BMC rheumatology · 2022Article
- Rheumatologist and Patient Mental Models for Treatment of Rheumatoid Arthritis Help Explain Low Treat-to-Target Rates.ACR open rheumatology · 2022Article
- Treat-to-target in axial spondyloarthritis: an observational study in daily practice.Rheumatology (Oxford, England) · 2022Observational
- Importance of Shared Treatment Goal Discussions in Rheumatoid Arthritis-A Cross-Sectional Survey: Patients Report Providers Seldom Discuss Treatment Goals and Outcomes Improve When Goals Are Discussed.ACR open rheumatology · 2021Article
- Management of rheumatoid arthritis in Poland - where daily practice might not always meet evidence-based guidelines.Archives of medical science : AMS · 2021Article
- Development of Monitoring System for Assessing Rheumatoid Arthritis within 5 Minutes Using a Drop of Bio-Fluids.Journal of clinical medicine · 2020Article
- Unlocking the Value of Anti-TNF Biosimilars: Reducing Disease Burden and Improving Outcomes in Chronic Immune-Mediated Inflammatory Diseases: A Narrative Review.Advances in therapy · 2020Review
- Physician Adherence to Treat-to-Target and Practice Guidelines in Rheumatoid Arthritis.Journal of clinical medicine · 2019Review
- Treat-to-target in rheumatoid arthritis - are we there yet?Nature reviews. Rheumatology · 2019Review
- Ten years of follow-up data in psoriatic arthritis: results based on standardized monitoring of patients in an ordinary outpatient clinic in southern Norway.Arthritis research & therapy · 2018Article
- EULAR 'points to consider' for the conduction of workforce requirement studies in rheumatology.RMD open · 2018Article
- Residual disease activity and treatment adjustments in psoriatic arthritis in current clinical practice.Arthritis research & therapy · 2017Observational
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
7 authors at 4 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionThe European League Against Rheumatism (EULAR) recommendations for the management of rheumatoid arthritis (RA) and the treat-to-target (T2T) principles have been developed in order to improve the treatment outcome of patients with RA, and have received broad attention. It is not clear, though, whether these recommendations are indeed followed up in clinical practice.
objectiveTo investigate if rheumatologists that report to agree with existing guidelines indeed follow them up in clinical practice.
methodsThe International Recommendation Implementation Study (IRIS) included 132 participating rheumatologists from 14 countries. Participating rheumatologists received a questionnaire measuring their awareness/commitment with the EULAR/T2T recommendations and followed a dedicated educational programme. Subsequently, they were asked to enrol 5-10 patients with new-onset RA in the online IRIS database and monitor disease activity and treatment for a period of 1-2 years. Four recommendations (3 from the EULAR recommendations and one from the T2T recommendations) were selected on the basis of testability, and analysed with regard to compliance by participating rheumatologists.
resultsIn total, 72 of the 132 participating rheumatologists contributed 378 patients to the database. Of these participants, 70 (98%) agreed upfront with the recommendation that disease-modifying antirheumatic drug (DMARD) therapy should be started as soon as possible after diagnosis in every patient; 69 (96%) of the rheumatologists agreed with the recommendation that methotrexate (MTX) should be part of the first treatment strategy. When measuring the actual performance, it was found that the recommendation on early DMARD start was met in 253 (67%) of the recorded patients, and the recommendation on MTX in 225 (60%) of the recorded patients. Of the participants, 60 (83%) agreed that composite measures should be recorded regularly, but only in 134(54%) of the patients were composite scores actually recorded in ≥50% of patient visits.
conclusionReporting to be compliant with EULAR recommendations and T2T principles, even after dedicated education does not mean they actually comply with it in clinical practice.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.