UK Audit Shows Early RA Referrals Still Too Slow Save

A national audit of rheumatoid arthritis (RA) and early inflammatory arthritis patients included 6,354 patients drawn from 143 trusts and health boards in England and Wales. Early arthritis clinics exist in 57% of trusts. The report examined the assessment, referral and early secondary care management of patients presenting with early inflammatory arthritis (EIA). (Citation source http://buff.ly/1K6ro9B)

This British Society of Rheumatology (BSR) report included patients with RA (2896), undifferentiated arthritis (1012), psoriatic arthritis (616) and peripheral spondyloarthritis (201). The RA patients had a mean DAS score of 5.0 at presentation. 

The report showed that 1 in 6 EIA or RA patients were referred by their GP to rheumatology within three days, and that 38% of patients were seen by rheumatology within three weeks of referral. However, 25%of patientswaited more than three months to be referred.

More than half of patients (53%) were treated with disease modifying drugs within six weeks, irrespective of whether they were seen within three weeks of referral. Glucocorticoids were used in 82% and combination DMARDs were used in 36% of patients at any time in the analysis. Education on RA was delivered within one month of diagnosis in 59% of patients.

Although a treatment target and timeframe was established at first consultation in 90%, the number who achieved that target was only 27%.

While many of these measures improved on the clinical care goals established by NICE, there were several areas that needed improvement. The report concluded with the following recommendations:

• Training and support should be given to primary care in order to raise awareness of the early symptoms and signs of inflammatory arthritis and importance of early referral.
• Rheumatology services and providers should assess how to increase clinical capacity, ensuring quicker access to rheumatologists and building suitable care packages in partnership with patients.
• The NHS should develop better systems for capturing, coding, and integrating outpatient information from clinics, including measures of patient experience and outcome.