Background Rheumatologists are critical to the appropriate diagnosis and treatment of rheumatoid arthritis (RA). EULAR recommends that early RA patients be referred to and treated by a rheumatologist within six weeks of onset of symptoms.
Objectives To detail the role of the rheumatologist in the diagnosis and treatment of RA patients and describe current quality of care from the patient perspective.
Methods Patients self-reporting a diagnosis of RA and residing in the United States completed a self-administered, internet-based questionnaire in the Fall of 2011. Patients provided details about providers who diagnosed and treated their RA. Patient satisfaction with care was defined as 5-7 (5=somewhat satisfied, 6=very satisfied, 7=extremely satisfied) on a 7-point Likert scale.
Results A total of 2138 patients (76% female, mean age 56.4) completed the questionnaire. Less than half were initially diagnosed with RA by a rheumatologist (48%); 46% were diagnosed by a primary care physician (PCP) and 6% by another specialist. Of those not initially diagnosed by a rheumatologist (n=1121), 38% were immediately referred to one and another 5% were referred within a year, but 41% were never referred to a rheumatologist. Among all patients, 27% never visited a rheumatologist. Patients who never visited a rheumatologist (n=529) reported various reasons: satisfaction with PCP (42%); physician never suggested it (35%); PCP is very knowledgeable about RA (34%); PCP is treating other conditions (28%); patient does not believe RA is severe enough (24%); nothing a rheumatologist would do differently (20%); out of pocket cost is too expensive (19%). Among all patients, 56% are currently seeing a rheumatologist, and 53% report that a rheumatologist is the primary treating physician; 41% are currently seeing a PCP for RA, and 33% report a PCP is the primary treating physician. Among patients currently seeing a rheumatologist (n=1202), 86% express satisfaction with care, and most patients are satisfied that their rheumatologist: is knowledgeable about RA (93%); lets patient talk freely (90%); communicates simply/clearly (89%); gives patient full attention (89%); is someone patient can trust (89%); takes concerns seriously (88%); explains options (87%); lets patient participate in treatment decisions appropriately (87%); provides effective RA treatments (86%); encourages patient to ask questions about treatment (84%); is open-minded about new treatments (84%).
Conclusions Rheumatologists play a key role in diagnosis and treatment of RA. However, there remain many patients who continue to rely solely on PCPs and who may benefit from a collaborative approach between PCPs and rheumatologists. Patients recognize the level of knowledge provided by rheumatologists. Patients currently treated by a rheumatologist have high satisfaction rates for quality of patient-physician communications and shared decision making.
Combe B, et al. 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 2007;66:34–45.
Disclosure of Interest S. Bolge Employee of: Janssen Scientific Affairs, LLC, B. Schenkel Employee of: Janssen Scientific Affairs, LLC, R. Lorenzo Consultant for: Janssen Scientific Affairs, LLC, V. Ramesh Consultant for: Janssen Scientific Affairs, LLC, M. Ingham Employee of: Janssen Scientific Affairs, LLC