EULAR/ standards of care for rheumatoid arthritis: cross-sectional analyses of importance, level of implementation and care gaps experienced by patients and rheumatologists across 35 European countries

Rachelle Meisters*, Polina Putrik, Sofia Ramiro, Monika Hifinger, Andras P. Keszei, Yvonne van Eijk-Hustings, Anthony D. Woolf, Josef S. Smolen, Tanja A. Stamm, Michaela Stoffer-Marx, Till Uhlig, Rikke Helene Moe, Maarten de Wit, Argjend Tafaj, Vahan Mukuchyan, Paul Studenic, Patrick Verschueren, Russka Shumnalieva, Paraskevi Charalambous, Jiri VencovskyMelpomeni Varvouni, Mart Kull, Kari Puolakka, Laure Gossec, Nino Gobejishvili, Jacqueline Detert, Prodromos Sidiropoulos, Marta Pentek, David Kane, Carlo Alberto Scire, Uri Arad, Daina Andersone, Mart van de Laar, Annette van der Helm-van Mil, Piotr Gluszko, Luis Cunha-Miranda, Florian Berghea, Nemanja S. Damjanov, Matija Tomsic, Loreto Carmona, Carl Turesson, Adrian Ciurea, Surayo Shukurova, Nevsun Inanc, Suzanne M. M. Verstappen, Annelies Boonen, Working group

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Objective As part of European League against Rheumatism (EULAR)/European Musculoskeletal Conditions Surveillance and Information Network, 20 user-focused standards of care (SoCs) for rheumatoid arthritis (RA) addressing 16 domains of care were developed. This study aimed to explore gaps in implementation of these SoCs across Europe.

Methods Two cross-sectional surveys on the importance, level of and barriers (patients only) to implementation of each SoC (0-10, 10 highest) were designed to be conducted among patients and rheumatologists in 50 European countries. Care gaps were calculated as the difference between the actual and maximum possible score for implementation (ie, 10) multiplied by the care importance score, resulting in care gaps (0-100, maximal gap). Factors associated with the problematic care gaps (ie, gap >= 30 and importance >= 6 and implementation= 6) were further analysed in multilevel logistic regression models.

Results Overall, 26 and 31 countries provided data from 1873 patients and 1131 rheumatologists, respectively. 19 out of 20 SoCs were problematic from the perspectives of more than 20% of patients, while this was true for only 10 SoCs for rheumatologists. Rheumatologists in countries with lower gross domestic product and non-European Union countries were more likely to report problematic gaps in 15 of 20 SoCs, while virtually no differences were observed among patients. Lack of relevance of some SoCs (71%) and limited time of professionals (66%) were the most frequent implementation barriers identified by patients.

Conclusions Many problematic gaps were reported across several essential aspects of RA care. More efforts need to be devoted to implementation of EULAR SoCs.

Original languageEnglish
Pages (from-to)1423-1431
Number of pages9
JournalAnnals of the Rheumatic Diseases
Issue number11
Publication statusPublished - Nov 2020



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