Details of systematic review undertaken for the guideline

The evidence base for this guideline was synthesised in accordance with SIGN methodology. A systematic review of the literature was carried out using an explicit search strategy devised by the SIGN Information Officer in collaboration with members of the guideline development group.

Searches were restricted to systematic reviews, meta-analyses, randomised controlled trials, and longitudinal studies. Inclusion criteria were patients with rheumatoid arthritis within five years of diagnosis, aged over 16. Exclusion criteria were studies based outside Western Europe, Scandinavia, North America, Australia or New Zealand; surgery; psychological treatments; social care or social support of patients.

Searches were carried out on the Cochrane Library, Embase, Medline, and Pascal from 1985 onwards. A subsearch on alternative or traditional therapies also looked at the Allied & Alternative Medicine and Mantis databases. All search strategies were evaluated by an independent information specialist.

The main searches were supplemented by material identified by individual members of the development group. All selected papers were evaluated using standard methodological checklists before conclusions were considered as evidence.

The question of late harm caused particular difficulties in searching. The section of the strategy on this topic focused on the long-term toxicity or toleration of DMARDs. It is recognised that this limited approach does not fully cover the literature on this subject, but given the restricted time available to complete the development process it was decided to accept this limitation.