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Early specialist referral is the key to improved long-term patient outcome

June 14, 2001

Timely identification of patients with early stage, active rheumatoid arthritis and referral to a specialist for treatment with drugs that have the potential to modify the disease process is the key to improving long-term patient outcome, say researchers.

Speaking at the Press Conference during EULAR 2001, the prestigious annual congress of the European League Against Rheumatism (EULAR), Dr Paul Emery, of Leeds University in the United Kingdom, presented sensitive evidence-based guidelines that can be used to optimise patient care. The new clinical guidelines, the Evidence-based Referral Recommendation (ERR), summarises essential diagnostic criteria derived from clinical studies. It can be used to identify potential rheumatoid arthritis (RA) patients who can then be rapidly referred to a rheumatologist for confirmation of the diagnosis.

"We know that for patients with active rheumatoid arthritis, early diagnosis and initiation of therapy with disease-modifying antirheumatic drugs (DMARDs) can substantially improve the long-term outcome of disease as well as overall quality of life," explained Dr Emery. "However, delay in referral to a rheumatologist for accurate and timely diagnosis is a major obstacle to early medical intervention." The researchers have now developed a robust and practical tool that will help to overcome this obstacle.

Dr Emery and his colleagues, drawn from other European and US universities, carried out a comprehensive literature search to gather information on targeting early RA and associated DMARD therapy, early RA clinics, signs and symptoms that indicate the progression of RA, and quality of life data. They identified, developed, and critically evaluated key points using supportive clinical evidence and also incorporated participants' views to achieve consensus.

"The ERR provides practical guidelines for the identification of patients with early RA. It should facilitate early referral and timely therapeutic intervention," says Dr Emery. The ERR states that clinical suspicion of RA can be supported by the presence of any of the following:
? more than, or equal to, three swollen joints
? metacarpophalangeal involvement - involvement of the joint between the bones of the hand (metacarpals) and the bones of the fingers (phalanges)
? metatarsophalangeal involvement - involvement of the joint between the bones of the midfoot (metatarsals) and the bones of the toes (phalanges)
? morning stiffness of more than, or equal to, 30 minutes.

If a patient presents with any of these symptoms the ERR states that they should be rapidly referred to a rheumatologist for confirmation of the diagnosis.

"Rheumatoid arthritis is a potentially devastating disease but, with improvements in existing treatments and the development of novel ones, we are better placed than ever to make a real difference. Early diagnosis and intervention with therapies such as DMARDs can make a difference to patients' health and ultimately to their quality of life," said Dr Emery.


Gardiner-Caldwell Communications Ltd