Background The waiting time for newly referred patients to the rheumatology clinic is approximately 24 months. The Rheumatology Nurse Rapid Access Triage Clinic aims to shorten the waiting time of patients suspected to have rheumatoid arthritis (RA). It is hoped that patients with active RA can be fast-tracked to commence earlier treatment for better disease control.
Objectives To validate if Rheumatology Nurses (RhN) can screen out patients with active RA for earlier treatment and to evaluate the level of agreement in RA diagnosis between RhN and rheumatologists.
Methods Newly referred patients suspected to have RA were assessed by RhN from March 2012 to September 2015. Based on a protocol modelled upon the 2010 European League Against Rheumatism (EULAR)/American College of Rheumatologists (ACR) criteria for the classification of RA, RhN performed history taking, physical examination of joints, and ordered relevant blood and X-ray investigations. RhN then reviewed all results to discriminate between RA and non-RA. Paired t-tests and logistic regression were used to compare variables between RA and non-RA patients diagnosed by RhN. Correlation coefficient (CC) was used to compare the level of agreement between RhN's and rheumatologists' assessment.
Results RhN assessed 102 patients (mean age =53.46 ± 12.59 years, 84.3% women). The group diagnosed to have RA by RhN had shortened waiting time for the rheumatology clinic when compared to the non-RA group. (11.5 vs 3.6 months; p<0.001) Agreement between RhN diagnosed RA and rheumatologist diagnosed RA was excellent (CC 90%; P<0.001). Comparing with the non-RA group, RhN diagnosed RA group also had greater chance of receiving disease modifying anti-rheumatic drugs (DMARDs) early (OR 43.08, p<0.001). The mean duration between onset of joint symptom and DMARDs commencement was 8.26 ± 11.52 months ranging from 3 to 52 months.
Conclusions The Rheumatology Nurse Rapid Access Triage Clinic provides accurate diagnosis and shortens RA patient's waiting time. It also helps to screen out active patients to receive earlier treatment.
Gormley GJ, Steele WK, Gilliland A, Leggett P, Wright GD, Bell AL, Matthew C, Meenagh G, Wylie E, Mulligan R, Stevenson M, Reilly DO and Taggart AJ (2003) Can diagnostic triage by general practitioners or rheumatology nurses improve the positive predictive value of referrals to early arthritis clinics? Rheumatology 42:763–768.
Disclosure of Interest None declared
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