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an increased risk of side effects and related complications patients’ resistance the requirement to prescribe glucocorticoids for 28 weeks difficulty to objectively assess side effects and/or the effectiveness of the individual compounds the requirement to prescribe > 10mg glucocorticoids as the initial dose lack of clear practical (inter)national prescription guidelines need for patient education interference with procedures in the organization the requirement to prescribe glucocorticoids in a combination scheme the requirement to prescribe leflunomide in a combination scheme the requirement to prescribe sulphasalazine in a combination scheme lack of scientific evidence lack of time during the consultations financial disincentives interference with usual daily routine lack of logistical, non-personal facilities within the workplace (e.g., place) lack of nursing support inadequate education and training about such treatment strategies a personal dislike compared to other treatment strategies low outcome expectation based on previous experiences lack of educational materials lack of non-nursing support (e.g., administrative support) fear to lose patients out of own practice the requirement to prescribe methotrexate in a combination scheme An exploration of the relative importance of barriers hindering intensive combination treatment strategies in early rheumatoid arthritis