AB0238 The Performance of A Single Centre Interventional Clinic in Early Rheumatoid Arthritis

BackgroundIn early rheumatoid arthritis (RA), first assessment by a rheumatologist and/or initiation of disease-modifying anti-rheumatic drugs (DMARD) within 12 weeks of symptom onset are associated with a significant benefit in long-term disease outcome.1,2ObjectivesTo determine the proportion of patients with newly diagnosed RA in whom first rheumatology assessment and/or initiation of DMARD therapy was within the desired time frame.MethodsA retrospective chart review of adult patients diagnosed with RA during year 2014 and the first half of year 2015 was performed at our rheumatology department, which is a part of an integrated secondary/tertiary teaching hospital that provides rheumatology services for a population of more than 500.000 residents. Potential cases were identified by searching the electronic medical records for ICD-10 codes M05.* and M06.* Electronic and paper records of patients were then thoroughly reviewed. Dates were recorded for onset of inflammatory joint symptoms, referral to rheumatologist, initial assessment by a rheumatologist and initiation of DMARD therapy. The percentage of patients assessed by a rheumatologist and/or treated with a DMARD within 12 weeks of symptom onset and the median times for delay were then calculated.ResultsBetween 01.01.2014 and 30.06.2015, 188 new cases of RA were identified at our Department of Rheumatology. Of those, 153 (81.4%) were referred to our early interventional clinic. Within 12 weeks of symptom onset, 89 (47.3%) new RA patients were examined by a rheumatologist and 68 (36.2%) were started on DMARD therapy; the median time from symptom onset to consultation was 12.8 (IQR 4.9–27.7) weeks, median time from referral to consultation was 1 (IQR 1–3) day and median DMARD treatment delay was 16.1 (IQR 8.6–32.8) weeks.Table 1.Demographic data, clinical history, and delaysGender (female/male) (%)143/45 (76/24)Age, years (mean ± SD)62.4±15.4DAS28 3v (mean ± SD)5.3±1.3Patients fulfilling 2010 ACR/EULAR classification criteria for RA, # (%)177 (94.1)Time from symptom onset to first rheumatologist assessment, weeks (median)12.8 (IQR, 4.9–27.7)Time from referral to first rheumatologist assessment, weeks (median)0.14 (IQR, 0.14–0.43)Time from symptom onset to glucocorticoid initiation, weeks (median)13.0 (IQR, 5.8–27.2)Time from symptom onset to DMARD initiation, weeks (median)16.1 (IQR, 8.6–32.8)Legend: SD: standard deviation, IQR: interquartile range.Conclusions47% of new RA patients were assessed by a r