Open-access Arthralgia Clinics Save

The early diagnosis in inflammatory arthritis (IA), particularly rheumatoid arthritis (RA), hinges on efficient referral and screening of arthralgia patients. Yet most rheumatology practices are ill equipped or don't have early arthritis clinics (EACs).  This report describes the use of an open-access arthralgia clinic (OAC) to manage primary care referrals and improve early diagnosis and treatment. 

 

This retrospective cohort analysis of a single center OAC (2013-2018) that provided brief rheumatological assessments of "arthralgia" patients referred from general practitioners. OACs may increase the proportion of rheumatoid arthritis patients diagnosed within the first three months of symptom onset.

 

As designed, the OAC was an intermediate triage step between GPs and the EARC. In Central Denmark these services were provided free of charge. OACs were promoted to local GPs, wherein arthralgia patients would undergo a brief 10 minute evaluation by a rheumatologist with or without imaging. GPs were encouraged to order IgM-rheumatoid factor (RF) and anti-citrullinated protein antibodies (ACPAs) tests prior to referral. These clinics operated twice weekly, and arthralgia patients were typically assessed within 1 week. Patients suspected of having inflammatory arthritis (IA) were referred to the Early Arthritis Clinic (EAC).

 

A total of 761 patients were evaluated at the OAC:

 

Of those seen at EAC, 11% were diagnosed with IA, half (5%) having RA; 32 (~20%) of whom were referred directly from the OAC. 

 

Compared with other RA patients, the 32 OAC-RA patients  had a shorter median time from symptom onset to diagnosis (92 vs 192 days, P < .05), with 47% diagnosed within 3 months. Disease activity at diagnosis was similar between OAC patients and RA controls, despite different disease durations.

 

OAC (Open-access Arthralgia Clinics) are efficient in screening, referring and diagnosing IA and RA patients. ven percent were later re-referred. Further research is needed to evaluate cost-effectiveness and to optimise referral criteria.