TOPLINE

Patients with rheumatoid arthritis (RA) referred through an early arthritis recognition clinic experienced significantly less functional disability and had more than twice the likelihood of sustained disease-modifying antirheumatic drug (DMARD)-free remission over 5 years compared with those referred through regular pathways.

METHODOLOGY

• A single-center, longitudinal, comparative effectiveness cohort study compared patients with RA referred through the early arthritis recognition clinic (recruited between August 2010 and January 2020; n = 122) with those referred through regular pathways (recruited between January 2006 and December 2009; n = 342).
• Patients fulfilled the 1987 or 2010 American College of Rheumatology or European Alliance of Associations for Rheumatology criteria for RA, had at least one swollen joint, and experienced symptoms for less than 2 years.
• The early arthritis recognition clinic was a walk-in screening clinic where rheumatologists performed comprehensive joint examinations; patients with confirmed clinical arthritis were referred to the rheumatology outpatient department within 1 week.
• Both groups received treatment in line with recommendations, with methotrexate as first-line therapy, and were followed up prospectively for 5 years at the Leiden Early Arthritis Clinic.
• Primary outcomes were functional disability, measured using the Health Assessment Questionnaire-Disability Index; disease activity, measured using the Disease Activity Score on 44 joints; and sustained DMARD-free remission (defined as sustained absence of clinical synovitis after DMARD discontinuation for at least 1 year).

TAKEAWAY

• Patients referred via the early arthritis recognition clinic had significantly lower functional disability over 5 years than regularly referred patients (beta = 0.14; P = .021). The findings were similar in adjusted analysis.
• Disease activity was significantly lower in early arthritis recognition clinic-referred patients over 5 years (beta = 0.26; P = .0003).
• Patients referred via the early arthritis recognition clinic were twice as likely to achieve sustained DMARD-free remission within 5 years (hazard ratio, 2.1; P = .0010).
• The median GP delay was significantly shorter for patients referred via the early recognition clinic than for those referred through regular pathways (5.14 vs 9.00 weeks; P < .0001). The median total delay was also shorter for patients referred via the early arthritis recognition clinic (12.0 vs 18.6 weeks; P = .0038).

IN PRACTICE

"The [study] results, therefore, have great added value because they indicate that an active intervention leading to an earlier diagnosis of rheumatoid arthritis, in combination with current treatment strategies, does indeed lead to better long-term disease outcomes. This finding underscores the importance of interventions aimed at earlier detection of rheumatoid arthritis," the authors wrote.

SOURCE

The study was led by Simonetta R.G. van Griethuysen, Leiden University Medical Center in Leiden, Netherlands. It was published online on August 11 in The Lancet Rheumatology.

LIMITATIONS

This single-center study may limit generalizability to other healthcare settings. The comparison involved groups from different time periods. GP delay was defined as the time from the first GP visit to the first visit at a rheumatology clinic, including referral time and waiting time in secondary care.

DISCLOSURES

This study was supported by the Dutch Arthritis Society. The authors reported having no competing interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.