Ann Rheum Dis 1999;58:510-513 ( August )

Concise report

Early referral, diagnosis, and treatment of rheumatoid arthritis: evidence for changing medical practice S Irvine, R Munro, D Porter

Department of Rheumatology, Gartnavel General Hospital, West Glasgow Hospitals University NHS Trust, 1053 Great Western Road, Glasgow G12 0YN

Correspondence to: Dr S Irvine.

Accepted for publication 12 March 1999

OBJECTIVESTo study the delay in starting disease modifying anti-rheumatic drugs (DMARDs) in patients with rheumatoid arthritis (RA), and any changes in medical practice between 1980 and 1997. 
METHODS198 consecutive RA patients attending the rheumatology clinics at a teaching hospital, for routine review, had their case sheet reviewed. The dates of symptom onset, general practitioner (GP) referral, first clinic appointment and first use of DMARD were recorded. Data were collected on the erythrocyte sedimentation rate, C reactive protein, rheumatoid factor, and the presence/absence of erosions at the first clinic assessment. Patients were split into four groups according to the date of their first clinic assessmentbefore 1986, 1987-9, 1990-3, and 1994-7.
RESULTSThere was a sharp drop in the delay between symptom onset and GP referral (before 1986, 21 months; 1987-89, 23 months; 1990-3, 7 months; 1994-7, 4 months, p<0.03), and in the delay between first assessment at the rheumatology clinic and the start of DMARD treatment (before 1986, 32 months; 1987-89, 21 months; 1990-1993, 8 months; 1994-7, 1 month, p<0.001). The number of patients given DMARD treatment within six months of symptom onset increased from 5% (before 1994) to 44% (1994-7). Seventy three per cent of patients waiting more than a year from symptom onset to first clinic appointment already had erosive change, compared with 34% of patients seen within a year.
CONCLUSIONSPatients are being referred earlier in their disease, and DMARDs are prescribed sooner in the disease course. There has been a substantial increase in the proportion of patients treated with a DMARD within six months of symptom onset.

---

© 1999 by Annals of the Rheumatic Diseases
CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

• Fautrel, B., Benhamou, M., Foltz, V., Rincheval, N., Rat, A.-C., Combe, B., Berenbaum, F., Bourgeois, P., Guillemin, F. (2009). Early referral to the rheumatologist for early arthritis patients: evidence for suboptimal care. Results from the ESPOIR cohort. Rheumatology (Oxford) 0: kep340v1-kep340 [Abstract] [Full Text]  
• Sheppard, J., Kumar, K., Buckley, C. D., Shaw, K. L., Raza, K. (2008). 'I just thought it was normal aches and pains': a qualitative study of decision-making processes in patients with early rheumatoid arthritis. Rheumatology (Oxford) 47: 1577-1582 [Abstract] [Full Text]  
• Kumar, K., Daley, E., Carruthers, D. M., Situnayake, D., Gordon, C., Grindulis, K., Buckley, C. D., Khattak, F., Raza, K. (2007). Delay in presentation to primary care physicians is the main reason why patients with rheumatoid arthritis are seen late by rheumatologists. Rheumatology (Oxford) 46: 1438-1440 [Abstract] [Full Text]  
• Combe, B, Landewe, R, Lukas, C, Bolosiu, H D, Breedveld, F, Dougados, M, Emery, P, Ferraccioli, G, Hazes, J M W, Klareskog, L, Machold, K, Martin-Mola, E, Nielsen, H, Silman, A, Smolen, J, Yazici, H (2007). EULAR recommendations for the management of early arthritis: report of a task force of the European Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT). Ann Rheum Dis 66: 34-45 [Abstract] [Full Text]  
• Peterfy, C G (2004). MRI of the wrist in early rheumatoid arthritis. Ann Rheum Dis 63: 473-477 [Full Text]  
• Breedveld, F C, Emery, P, Keystone, E, Patel, K, Furst, D E, Kalden, J R, St Clair, E W, Weisman, M, Smolen, J, Lipsky, P E, Maini, R N (2004). Infliximab in active early rheumatoid arthritis. Ann Rheum Dis 63: 149-155 [Abstract] [Full Text]  
• Morgan, C, Lunt, M, Brightwell, H, Bradburn, P, Fallow, W, Lay, M, Silman, A, Bruce, I N (2003). Contribution of patient related differences to multidrug resistance in rheumatoid arthritis. Ann Rheum Dis 62: 15-19 [Abstract] [Full Text]  
• Aletaha, D., Smolen, J. S. (2002). The rheumatoid arthritis patient in the clinic: comparing more than 1300 consecutive DMARD courses. Rheumatology (Oxford) 41: 1367-1374 [Abstract] [Full Text]  
• Potter, T., Mulherin, D., Pugh, M., Emery, P., Quinn, M., Conaghan, P. (2002). Early intervention with disease-modifying therapy for rheumatoid arthritis: where do the delays occur?. Rheumatology (Oxford) 41: 953-955 [Full Text]  
• Saraux, A, Maillefert, J F, Fautrel, B, Flipo, R M, Kaye, O, Lafforgue, P, Guillemin, F, Botton, E (2002). Laboratory and imaging studies used by French rheumatologists to determine the cause of recent onset polyarthritis without extra-articular manifestations. Ann Rheum Dis 61: 626-629 [Abstract] [Full Text]  
• Aletaha, D, Eberl, G, Nell, V P K, Machold, K P, Smolen, J S (2002). Practical progress in realisation of early diagnosis and treatment of patients with suspected rheumatoid arthritis: results from two matched questionnaires within three years. Ann Rheum Dis 61: 630-634 [Abstract] [Full Text]  
• Jansen, L M A, van der Horst-Bruinsma, I E, van Schaardenburg, D, Bezemer, P D, Dijkmans, B A C (2001). Predictors of radiographic joint damage in patients with early rheumatoid arthritis. Ann Rheum Dis 60: 924-927 [Abstract] [Full Text]  
• COURTNEY, P A, WRIGHT, G D (2001). Referrals to an "early synovitis clinic": are they appropriate?. Ann Rheum Dis 60: 991-992 [Full Text]