Background Rheumatoid arthritis (RA) is an autoimmune, chronic, inflammatory disease. RA is the most common inflammatory disease in the Western World and its association with bone erosion, deformity, disability and systemic involvement have long term effects on patient quality of life and socioeconomic costs. Longitudinal, observational studies have shown that patients treated early have significantly less radiographic damage than those treated later.
Objectives The objectives of our audit were to check our practice against four of the National Quality Standards (National Institute of Clinical Excellence 2013) for RA patients and check for compliance. We assessed the following: if patients presented to the GP with symptoms within three months or fewer; if the referral to rheumatology was within three days; if patients were assessed by rheumatology within three weeks and were started on treatment within six weeks of referral and, finally, if the patients were monitored using an outcome measure in their initial rheumatology consultation.
Methods The audit was undertaken in the rheumatology department at UCLH during a three month period from June-October 2013. All new patients, aged ≥18 years, who met the diagnosis criteria for RA were included. The patients were captured from our weekly, early arthritis clinics. We reported the results using descriptive statistics.
Results There were 96 new patients referred to the department. Of these, 20 were diagnosed with RA, according to EULAR criteria (2010) (90% female, mean age 48.5±15.5 and 10% male, mean age 51.5± 9.2). The median duration from symptom onset to GP presentation was 2.5±1.97 months (interval 1 week to 3 years). Patients were seen in our clinics 4.15±2.23 weeks after the GP referral. The majority of patients were diagnosed on the same day; mean time to diagnosis from first specialist appointment was 2.26±3.14 weeks. A DAS-28 was documented in 60% of patients on the initial consultation, the average score was 5.2. The mean duration from GP referrals to rheumatologists' diagnoses was 6.7±3.87 weeks. Within six weeks of referral from the GP, 50% of patients were given an IM Depomedrone injection, DMARD therapy was started in 75% of cases and treatment strategy discussed in 100% of cases.
Conclusions Based on our result from this preliminary audit, our department were found to be working towards the four quality standards in RA. At present, we fulfil 3/4 quality standards looking at the early steps in the RA patients' journey. The results show that there we have reduced capacity in seeing patients more quickly; however, overall, time to diagnosis was minimal, often on the same day. The results show that the DAS-28 is the clinician preferred outcome measure for assessing patients at baseline. The mean duration from symptom onset to presentation at the GP should be improved, with the view to start treatment for all patients within the window of opportunity. Adhering to these quality standards will help significantly in striving to reach the goal of preventing irreversible damage to joints and the further systemic complications associated with RA.
National Institute of Clinical Excellence (NICE). NICE quality standard 33 Quality Standards for Rheumatoid Arthritis. London: NICE, 2013.
Disclosure of Interest : None declared
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