Background Early diagnosis of rheumatoid arthritis (RA) is of paramount importance as early effective treatment reduces long-term morbidity and mortality (1,2). Evidence suggests that simple clinical criteria, facilitates earlier referral of patients with suspected RA from general practitioners (GP's) to the rheumatologist (3).
Objectives Our hypothesis: Supplementary education of GP's to identify RA and refer to an Early Arthritis Clinic (EAC) shortens time to remission compared to referral to a mixed outpatient clinic.
Methods In July 2011, an EAC was established in Holbæk Hospital. GP's in the hospitals catchment area were informed of the clinic, educated in the referral criteria and encouraged to refer patients suffering unspecific arthritis symptoms at early disease stages. A standardised referral form was contrived to simplify the referral process. Patients referred and diagnosed with RA were followed until remission. Patients in the trial were enrolled from July 2011 to April 2015. Controls were patients referred prior to the establishment of the EAC. The main outcome parameter was time from referral to low DAS28 <3.2 or remission at DAS28 <2.6. All patients were registered in the mandatory nationwide database DANBIO (4). Patients were evaluated and monitored by rheumatologists or rheumatology specialist nurses in the DANBIO at regular intervals and DAS28 was calculated at each visit. A Kaplan-Meier plot was calculated and compared using the log-rank test. The two groups were compared using the X2-test.
Results As shown in the table, the two groups, EAC vs. controls, were similar in gender distribution. A relatively large proportion in each group already appeared to be in remission at the entry point, up to 16%, probably reflecting the proportion with only slight or minor disease activity. There was a significant proportion in the EAC that achieved both DAS28<3.2 and DAS28<2.6 compared to the control group. Likewise, a conspicuous difference was observed among the patients never achieving remission. The two Kaplan-Meier plots show the timely difference was highly significant indicating that time of remission was achieved very early.
Conclusions Establishing an early arthritis clinic and supplementary RA education of GP's shortens time to early disease activity or remission in patients with RA.
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Danish Rheumatology Database. https://danbio-online.dk 2010
Acknowledgement Abbvie has supported this study with an unrestricted grant
Disclosure of Interest None declared
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