More than ten years have passed since the first UK guidelines for the management of rheumatoid arthritis were published. Since then many different guidelines have been produced, including contributions from the American College of Rheumatology and the Scottish Intercollegiate Guidelines (SIGN) network. These give similar recommendations on management. For example, they all stress the need for starting disease-modifying drugs early. The North American guidelines codify the range of acceptable

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... ctice, rather than giving specific detailed recommendations. By contrast the SIGN guidelines are more prescriptive and delineate what the authors consider to be 'best clinical practice'. The next step is to introduce guidelines that focus on specific aspects of care, rather than defining the whole range of management options. This is already happening with the introduction of guidelines for high cost treatments such as immunotherapy directed at anti-tumour necrosis factor.