Multiple Delays in Referral of New RA Patients Save

A UK study of early onset arthritis or new rheumatoid arthritis patients shows multiple sources of delayed referral to the first rheumatology consultation.

A total of 822 patients (563 female, mean age 55 years) were enrolled from 34 National Health Service trusts in England and Scotland, including networks such as the Early Rheumatoid Arthritis Network and the National Institute for Health Research Clinical Research Network. To be enrolled, adult patients had to have clinically apparent synovial swelling of one or more joints or a diagnosis of unclassified arthritis (UA) or new onset of RA (according to 2010 American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) criteria.

Key findings included:

• The median time between symptom onset and rheumatology consult was 27.2 weeks (IQR 14.1-66 weeks).
• Only 20% of patients were seen within the first 3 months of symptom onset.
• The median patient delay was 5.4 weeks (IQR 1.4-26.3 weeks).
• The median general practitioner delay was 6.9 weeks (IQR 2.3–20.3 weeks).
• Patients had a mean of 4 GP visits before being referred.
• The median hospital delay was 4.7 weeks (IQR 2.9–7.5 weeks).

Delays were prolonged in patients who purchased over-the-counter medications or used ice/heat packs took longer to seek help than those who did not.

Patients with a palindromic or an insidious symptom onset delayed for longer than those with a non-palindromic or acute onset.

The interval between first consultation with a rheumatologist and initiation of treatment was not measured in this study.

Multiple delays (patient, PCP, hospital, etc) contributed to a longer than expected time from symptom onset to rheumatologic evaluation. Patient education and delays by primary care providers will require interventions to promote more timely referrals.