07 October 2026
A new national audit has found that starting treatment earlier is associated with better outcomes for people with early inflammatory arthritis, while significant variation in access to timely care remains between rheumatology services.
The 2026 National Early Inflammatory Autoimmune Diseases Audit (NEIAA) State of the Nation report found that patients who started disease-modifying anti-rheumatic drug (DMARD) treatment at their first rheumatology appointment had 48% higher odds of achieving clinical remission at three months
compared with those who did not. Modelling suggests that up to 534 additional patients may have achieved early clinical remission if treatment had been initiated at their first appointment.
The audit, which covered more than 10,000 patients across England, Wales and Jersey, also shows that substantial variation remains between services, including in the diagnosis and care of people with rarer rheumatic diseases. The report highlights wide variation in diagnostic journeys for these conditions, where delays to diagnosis and treatment can be associated with significant complications. Across providers, the proportion of patients receiving treatment within the NICE quality standard target of six weeks ranged from 4% to 98%, highlighting both the scale of variation and the potential for improvement.
Professor James Galloway, Lead Methodologist for NEIAA, said: “Our national audit programme is unique in providing a longitudinal picture of outpatient rheumatology care for these patient groups, giving us valuable insight into the care people experience in the first weeks and months after a new autoimmune diagnosis. The findings continue to drive change, helping us understand where care is excellent and where teams need support to improve. Continuous quality measurement must remain a core part of the NHS, and the rheumatology community is a superb example of that commitment.”
Dr Lesley Kay, National Clinical Director for Musculoskeletal Conditions at NHS England and National Clinical Co-Lead for Rheumatology for the GIRFT programme, said: “This report is the result of a huge amount of work by the British Society for Rheumatology team and rheumatology clinical and operational teams across England, Wales and Jersey. It is an extremely valuable resource, providing a unique picture of how services for people with these important conditions are working on the front line and the impact that early intervention can have. We are already seeing excellent examples of teams using their own data to drive meaningful clinical improvements, and I look forward to seeing many more services use these insights to improve patient care.”
Dedicated pathways linked to faster care
Patients referred through a dedicated early inflammatory arthritis pathway were more likely to receive timely care. 45% were assessed within three weeks, compared with 35% of patients referred through other routes, while 57% received treatment within six weeks, compared with 43%.
The findings reinforce the importance of service design, including effective triage, dedicated early inflammatory arthritis clinics and rapid access to treatment.
Sarah Campbell, CEO of the British Society for Rheumatology, said: “The variation we see between services is significant, but this report also demonstrates that improvement is achievable. NEIAA provides services with the data they need to understand where delays are occurring, benchmark their performance and identify opportunities to improve care. Continued participation in the audit is essential if we are to keep identifying where change is needed, support quality improvement, and measure whether changes are making a difference.”
Better outcomes can make a difference to patients’ everyday lives
The report also highlights the wider impact of effective treatment. Patient-reported outcome measures showed improvements in both work productivity and musculoskeletal health during the first year after diagnosis. Median work impairment reduced from 30% at presentation to around 20% at 12 months, while median MSK Health Score increased from 24 to 37.
Earlier disease control was also associated with better employment outcomes, reinforcing the wider impact that timely diagnosis and effective treatment can have on patients, families and the economy.
Dr Elizabeth Price, NEIAA Clinical lead, said: “These findings are ultimately about improving outcomes that matter to patients. Earlier treatment and better disease control can make a meaningful difference not only to clinical remission, but to people’s ability to work, function and manage everyday life. That is why reducing delays and variation between services remains so important.”
From audit to action
The report demonstrates that improvement is achievable. Oxford University Hospitals NHS Foundation Trust had become a national outlier following the COVID-19 pandemic, but after using NEIAA data to identify and address problems within its pathway, patients receiving treatment within 6 weeks increased from 20% to 65%.
Changes included reviewing NEIAA data at monthly management meetings, mapping the patient pathway to identify bottlenecks, increasing senior clinical capacity, expanding nurse-led follow-up and embedding audit data collection into routine clinical care.
The report also highlights sustained high performance at services using dedicated triage, rapid-access clinics and same-day treatment models, demonstrating that national standards are achievable when the right systems are in place.
Dr Mark Russell, Lead Methodologist for NEIAA, said: “The Oxford case study demonstrates how audit data can drive improvement. By regularly reviewing performance identifying delays and making targeted changes to the patient pathway, the team substantially improved treatment timeliness. NEIAA data is most powerful when it is used routinely to understand performance, guide service development and measure the impact of change.”
Clinicians encouraged to compare their service
The British Society for Rheumatology is encouraging rheumatology teams to use the report alongside NEIAA's trust and health board reports and live dashboard to understand how their service compares nationally, identify opportunities for improvement and evaluate service changes.
Clinicians are encouraged to:
- read the 2026 State of the Nation report
- review their trust or health board's performance using NEIAA data and the live dashboard
- use the findings within MDT and service improvement discussions
- continue submitting complete and timely data to NEIAA, allowing services to benchmark performance and monitor improvement over time.
NEIAA users with Clinical Admin access can also download their own data and use the audit's data analysis tool to explore performance in greater detail, including individual cases where standards were not met.
Five national recommendations
The report makes five national recommendations, including calls for Integrated Care Boards, Welsh Health Boards and the Getting It Right First Time programme to identify services without effective referral pathways or dedicated early inflammatory arthritis clinics, and support them to introduce models that enable faster assessment and treatment.
It also calls for greater use of patient-reported outcome measures and sufficient administrative and data-management capacity to support high-quality audit participation and local quality improvement.
Read the full NEIAA State of the Nation Report 2026
View the NEIAA dashboard and compare local performance
Find out more about NEIAA
Notes to editors
The National Early Inflammatory Autoimmune Diseases Audit is the only national clinical audit examining how quickly people with inflammatory arthritis, connective tissue diseases and systemic vasculitis are diagnosed, assessed and treated across England, Wales and Jersey.
The British Society for Rheumatology (BSR) is the leading UK specialist medical society for rheumatology and musculoskeletal care professionals. BSR supports its members to deliver the best possible care across the patient pathway, helping improve the lives of children and adults with rheumatic and musculoskeletal conditions. Its work includes clinical guidance, education, quality improvement, research, policy and professional support.
The 2026 report covers diagnoses recorded between 1 April 2025 and 31 March 2026. In Year 8, 96% of eligible providers participated, with data submitted for 10,695 patients.
NEIAA is commissioned by the Healthcare Quality Improvement Partnership and funded by NHS England and the Governments of Wales and Jersey as part of the National Clinical Audit and Patient Outcomes Programme.