HCPLive Network

The Earlier Rheumatoid Arthritis Is Treated, the Better

Positive outcomes in rheumatoid arthritis (RA) are closely linked to early diagnosis and treatment with disease-modifying antirheumatic drugs (DMARDs).
A study by researchers in the Netherlands found that patients who are assessed by rheumatologists soon after RA symptoms appear are more likely to experience less joint destruction and improved chances of DMARD-free disease remission. The study is published in the December issue of Arthritis & Rheumatism.
The World Health Organization (WHO) estimates that RA affects up to 1% of the population worldwide and is associated with increased morbidity, mortality, and healthcare costs.
The chronic, systemic disease is characterized by inflammation in the lining of the joints which can frequently lead to joint damage. Current medical evidence suggests that early initiation of an optimal RA treatment strategy within 12 weeks of symptom onset can prevent joint damage, improve long-term function, and increase the likelihood of achieving disease remission.
Dr. Michael van der Linden and colleagues from the Leiden University Medical Center examined 1674 early arthritis patients from the Leiden Early Arthritis Clinic cohort. Of those participants, 598 (36%) were RA patients who were diagnosed between 1993 and 2006.
Researchers studied the associations among total delay to physician assessment, achievement of DMARD-free-remission, and the rate of joint damage over a six-year follow-up period. Total delay was calculated as the sum of "patient delay" (time from symptom onset until patient seeks and is assessed by a general practitioner (GP)) and "GP delay" (time lapse between seeing the GP and a referral to- and appointment with a rheumatologist).
Results showed the median patient, GP, and total delay in evaluation of early arthritis patients were 2.4, 8.0, and 13.7 weeks, respectively. "Early treatment intervention dramatically improves clinical outcomes in patients with RA," said Dr. van der Linden, in a press release. "Our study presents the first evidence that RA patients who have a delay longer than 12 weeks between first symptoms and visiting a rheumatologist have a higher rate of joint destruction and lower chance of achieving a sustained DMARD-free remission."
In 69% of RA patients, an examination by a rheumatologist took place 12 or more weeks after symptoms began, which researchers suggest contributed to a joint destruction rate that was 1.3 times higher than patients assessed prior to 12 weeks. A delay in treatment was also associated with greater risk (1.87 hazard ratio) of not achieving DMARD-free disease remission.
In a related editorial published in this month's issue, Dr. Paul Emery, Arthritis Research UK Professor of Rheumatology and Head of Musculoskeletal Diseases at Chapel Allerton Hospital in the United Kingdom, and Dr. Vivian Bykerk from Brigham and Women's Hospital in Boston, Massachusetts point out that previous studies showed delays to care are frequent, but the study by van der Linden et al. was the first to actually document the negative impact of delayed RA treatment.
"These data provide further evidence that rheumatologists have the greatest impact on patients with RA when they intervene early in the disease course," commented Dr. Emery, in the editorial. He further noted strategies that may help reduce delays in care such as prescreening referrals, an introduction of a specialized rheumatology referral form for GPs to use that identify urgent referrals, or set-up of central triage clinics.
Dr. van der Linden concluded, "Our results highlight the importance of reducing the delay in assessment by a rheumatologist and further studies could test whether accelerated treatment leads to improved disease outcomes in RA." The ACR and European League Against Rheumatism (EULAR) have set up a task force to address the issue of improving RA patient outcomes through early intervention.
Sources: Wiley - Blackwell, AlphaGalileo Foundation.
Are the findings consistent with what you have seen in your practice? Leave a comment.

Further Reading
In remarks delivered at the American Academy of Family Physicians 2014 Assembly, HHS Secretary Sylvia Mathews Burwell spoke about the ongoing response to the Ebola outbreak, improving health care delivery, the Affordable Care Act, and the Transforming Clinical Practice Initiative.
New York and New Jersey health officials announced today that all health care workers returning from caring for patients in Ebola hot zones in West Africa will have to go into quarantine for 21 days. The new policy is stricter than the current one recommended by the US Centers for Disease Control and Prevention that calls for health monitoring for 21 days. It was that policy that allowed Craig Spencer, MD to be out and about a day before he was diagnosed with Ebola Thursday and rushed to city-run Bellevue Hospital Center in Manhattan.
Recent pharmaceutical studies show work in helping patients with high blood pressure and elevated cholesterol levels.
New York City officials Said Craig Spencer MD, the emergency physician is being treated for Ebola treating patients with the virus in Guinea, African is in stable condition. Meanwhile in Bethesa, MD, Nina Pham, the Dallas nurse who was the first person to contract the disease on US soil, was released from a National Institutes of Health hospital after being declared free of the virus.
For patients diagnosed with osteoarthritis, daily activities that many people take for granted, including sleep, can be interrupted or difficult, often causing psychological challenges as well.
Targets of workplace bullying can offer chaos, report, or quest narratives about their experiences, and coworker response plays a role in narrative development, according to a study published online Sept. 25 in Management Communication Quarterly.
In what could be New York City’s first case of Ebola, a doctor identified by the NY Post as Craig Spencer, 33, MD an emergency medicine physician at New York Hospital/Columbia-Presbyterian was rushed to a special Ebola unit at city-run Bellevue Hospital Center in Manhattan. Spencer returned 10 days ago from a stint as a volunteer with Doctors without Borders, caring for Ebola victims in Guinea, one of three West African nations with major outbreaks.
More Reading