Background Data of multiple observational cohorts and trials indicate that rheumatoid arthritis patients who were treated in a very early disease phase had a better outcome; these patients developed more often spontaneous remission and less joint damage. Recognizing arthritis in the first 12 weeks after symptom onset is therefore of great importance. In the Leiden area, only 31% of the patients were identified within 12 weeks. General practitioner (GP) delay was the major contributor to the total delay (median 11.8 weeks out of a total delay of 18.4 weeks).1 It appeared that GPs have difficulties in recognizing arthritis of small joints in an early phase and in case of doubt “wait-and-see''. To diminish this GP delay we initiated an Early Arthritis Recognition Clinic (EARC) and GPs were encouraged to send any patients to the EARC in whom they doubted about the presence of synovitis. On the EARC, patients were screened, by experienced rheumatologists, for the presence of synovitis. The EARC was initiated at two places (Leiden and Groningen University Medical Center).
Objectives The present study aimed to evaluate the first year results of the EARC and to study whether this initiative decreased the delay in recognizing arthritis.
Methods 400 Patients visited the Leiden EARC and 212 patients the Groningen EARC. At this screening clinic, patients filled in a form with questions about their symptoms and motivations to seek medical attention. Immediately hereafter, they were seen by an experienced rheumatologist for a full joint examination. In case of presence of arthritis patients were seen back within one week for a full work-up. We studied the total delay (period between first symptom and first visit to the EARC), the GP delay (period between first visit at the GP and first visit at the rheumatologists) and patient delay (period between the first symptom and the first visit to a GP). The effectiveness of the EARC was evaluated with the GP delay.
Results Arthritis was detected in 42.3% of the patients seen in Leiden and in 49.1% of the patients seen in Groningen. In these arthritis patients, the median patient delay was 2.6 (IQR 0.6-8.9) and 2.7 (IQR 0.9-10.3) weeks respectively. The median GP-delay was 2.0 (0.4-7.2) and 2.0 (0.4-10.0) weeks and the median total delay was 8.6 (3.4-22.3) and 10.6 (3.1-30.8) weeks for Leiden and Groningen patients respectively. In addition, 56.8% and 44.2% of the patients with arthritis were seen within 12 weeks after symptom onset. Analyzing only the early arthritis patients that were initially diagnosed with UA or RA revealed that 63.2% and 38.6% respectively were seen <12 weeks after symptom onset.
Conclusions This established EARC reduced the GP delay from 8 weeks to 2 weeks and the percentage of patients that were recognized <12 weeks in the Leiden area almost doubled. Although a longer follow-up of these patients is required to evaluate whether this referral strategy improves the long term outcome, the current data indicate that this EARC importantly increases the early identification of arthritis and RA.
 van der Linden MP, le Cessie S, Raza K, et al., Arthritis Rheum 2010;62:3537–46.
Disclosure of Interest None Declared
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