- Reducing GP Referral Delays with Arthritis Screening
The early arthritis recognition clinic, where rheumatologists directly evaluate patients for clinical arthritis, was established as a result of this delay; nevertheless, its long-term efficacy is yet unknown.
- The Leiden Early Arthritis Clinic’s Comparative Cohort Study
Researchers compared patients with rheumatoid arthritis referred through the early arthritis recognition clinic (recruited 2010-2020) with similar patients referred through standard methods (recruited 2006-2009) in a single-center, longitudinal, comparative efficacy cohort study. The Leiden Early Arthritis Clinic provided both groups with comparable care and a five-year follow-up.
A linear mixed model was used to analyze the Disease Activity Score and functional disability as determined by the Health Assessment Questionnaire-Disability Index, whereas Cox regression was used to analyze sustained DMARD-free remission.
- Early Arthritis Clinic Linked to Better Outcomes and Faster Referral
Of the 2,081 patients assessed through the early arthritis recognition clinic pathway, 818 had clinical arthritis. Among these, 122 patients with rheumatoid arthritis were included in the study, with women accounting for 59%. Of the 690 patients referred through the regular pathway, 342 patients with rheumatoid arthritis were included, with 66% being female.
Over the five-year follow-up period, patients referred through the early arthritis recognition clinic had lower disease activity (β=0.26, 95% CI 0.12 to 0.41, p=0.0003) and less functional disability (β=0.14, 95% CI 0.02 to 0.25, p=0.021) compared with those referred through the regular pathway. They also had a higher likelihood of achieving sustained drug-free remission (hazard ratio 2.1, 95% CI 1.34 to 3.16, p=0.0010).
Patients identified through the early arthritis recognition clinic also experienced a shorter median GP delay than those referred through the regular pathway. The median delay was 5.14 weeks (IQR 1.86 to 11.43) compared with 9.00 weeks (IQR 5.00 to 20.14), respectively (p<0.0001).
- Consequences for Rheumatoid Arthritis Early Detection Routes
According to these results, patients with rheumatoid arthritis may have better long-term results and less referral delays if an early arthritis detection clinic was established. Causality cannot be definitively proven because this was a non-randomized comparison between two historical cohorts. According to the authors, this is one of the first studies showing that active intervention to speed up diagnosis seems to improve long-term outcomes.
