Latest NEIAA ‘State of the Nation’ report released

09 October 2026

The National Early Inflammatory Audit (NEIAA) State of the Nation report is an important document that shows how effectively people with suspected RA, and other inflammatory arthritis, receive specialist care across England and Wales in those vital early months living with the condition.

The audit plays an important role in tracking performance against national quality standards, identifying delays and variations between services, supporting improvements in diagnosis, treatment and patient outcomes and providing vital evidence for service design and treatment guidance.

This year’s report highlights again the importance to outcomes of early assessment of symptoms and early access to medications. NRAS is particularly pleased to see national recommendation three, which calls for a strengthening of national guidance to ’emphasise the importance of early treatment escalation for patients with poor prognosis factors’.

People with high disease activity at diagnosis are, according to the report, roughly 50% less likely to achieve remission at three months compared to those with lower activity. This means they are more likely to encounter long-term joint damage and difficulty with daily activities and work as well as the pain and fatigue associated with RA.

The current guidelines for treatment mean that people with severe RA at diagnosis must cycle through two cDAMRDS before they can access advanced treatments. Evidence suggests that starting treatment with a combination of conventional and biologic drugs could significantly improve remission rates.

With the cost of biologic drugs now similar to those of conventional therapies, it seems like the time is right for a strengthening of guidance to ensure people with poor prognosis factors are offered the right medications as quickly as possible after diagnosis. With RA there is time to wait to get the right treatment.