NICE recommends that patients with rheumatoid arthritis be treated with methotrexate and at least one other DMARD within three months of diagnosis.

But a NICE report published last month shows most patients miss out on this recommended treatment.

The guidelines also state that patients with rheumatoid arthritis should be reviewed annually to monitor disease progression, associated comorbidities and drug side-effects.

The report found just 11 per cent of patients had been monitored in the past year.

However, the authors pointed out that monitoring is not consistently recorded, and this figure may be an underestimate.

PCTs spent more than £1.5 million on biological agents in 2008/9, up 50 per cent compared with the previous year.

The report suggests that GPs are increasingly willing to prescribe biological agents: prescriptions for the TNF-alpha blocker adalimumab rose by 48 per cent in the course of a year, and etanercept is also being prescribed more often.

Prescriptions for DMARDs also rose by 10 per cent, further contributing to the rising cost of pharmacological treatment for the disease.

NICE estimates that 400,000 people in the UK suffer from rheumatoid arthritis, although recent studies have placed this figure much higher.

The disease has a significant impact on the economy, with a third of sufferers choosing to stop work within two years of diagnosis due to pain and disability.

Drug management aims to relieve symptoms and to slow or stop disease progression.

NICE's report into the uptake of its guidance on rheumatoid arthritis in adults is available from its website.