Early rheumatoid arthritis treatment with rheumatologist improves disease outcomes

Key Points

Patients with rheumatoid arthritis (RA) who are seen by a rheumatologist within 12 weeks of symptom onset were likely to experience less joint destruction and have a higher chance of achieving disease modifying anti-rheumatic drug (DMARD)-free remission, according to a new study published December 2010 in Arthritis & Rheumatism. Despite this, researchers' findings suggest that more than two-thirds of patients with RA go longer than 12 weeks from symptom onset before seeing a specialist.

"Rheumatologists nowadays are aware of the need to treat early," noted Michael P. van der Linden, lead author of the paper. "This implies that to further improve the outcome of RA, strategies should be established to ensure that delays in assessment are as brief as possible.

"Understanding the factors associated with delayed assessment is the first step required to achieving this goal," he continued.

REASONS FOR DELAYED CARE

Study results suggested that the delay in seeing a rheumatologist was disproportionally due to delays in making appointments and seeing general practitioners, (median, 11.8 weeks, interquartile range, 5.2 to 22.9) as compared to delays in referral and scheduling appointments to see a rheumatologist (median, 3.3 weeks, interquartile range, 1.0 to 8.9) (P<.0001). Identified predictors of delay in seeing a rheumatologist included older age, female sex, gradual symptom onset, involvement of the small joints, lower levels of C-reactive protein, and the presence of autoantibodies.

The researchers' analysis also demonstrated the importance of early care by a rheumatologist. The 69% of RA patients not seen within 12 weeks had a nearly 2-fold (HR=1.87; 95% CI, 1.18–2.99; P=.008) increased hazard of not achieving DMARD-free remission and a 34% increased rate of joint destruction as measured by the Sharp/van der Heijde assessment (SHS).

SOURCE

van der Linden MP, le Cessie S, Raza K. Long-term impact of delay in assessment of patients with early arthritis. Arthritis & Rheumatism. 2010;62(12):3537–3546.