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Improved early identification of arthritis: evaluating the efficacy of Early Arthritis Recognition Clinics
  1. Jessica A B van Nies1,
  2. Elisabeth Brouwer2,
  3. Floris A van Gaalen1,
  4. Cornelia F Allaart1,
  5. Tom W J Huizinga1,
  6. Marcel D Posthumus2,
  7. Annette H M van der Helm-van Mil1
  1. 1Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
  2. 2Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center, Groningen, The Netherlands
  1. Correspondence to Jessica A B van Nies, Department of Rheumatology, Leiden University Medical Center, P.O. Box 9600, Leiden 2300 RC, The Netherlands; j.a.b.van_nies{at}lumc.nl

Abstract

Objective Only 31% of Dutch rheumatoid arthritis (RA)-patients visit a rheumatologist within 12 weeks after symptom onset; this is mainly due to delay at the level of the general practitioner (GP). In order to reduce delay of GPs in identifying early arthritis, we initiated an Early Arthritis Recognition Clinic (EARC).

Methods EARCs were initiated at the Leiden and Groningen University Medical Centers. At this EARC, patients filled in a questionnaire about their symptoms, followed by a short visit with only a full joint examination by an experienced rheumatologist. If arthritis was present the patient got an appointment the same week at the regular outpatient clinic. The main outcome parameter was the GP-delay; the secondary outcome parameter was the total delay. In both centres, patients included in early arthritis clinics that had arrived via regular referrals served as control group.

Results Four hundred patients visited the Leiden EARC and 212 patients the Groningen EARC. Arthritis was detected in 42% and 49% respectively. The median GP-delay for these arthritis patients was 2.0 (0.4–7.3) and 2.0 (0.4–10.0) weeks and the median total delay 8.6 (3.6–22.3) and 10.6 (3.1–30.8) weeks respectively. At these two clinics 59% and 51% of all arthritis patients and 65% and 53% of the patients that were subsequently diagnosed with undifferentiated arthritis or RA were seen within 12 weeks after symptom onset. In the Leiden and Groningen control groups that arrived via regular referrals, only 32% and 38% were seen within 12 weeks time.

Conclusions The EARC increased the early identification of arthritis and RA.

  • Early Rheumatoid Arthritis
  • Epidemiology
  • Outcomes research

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