Practical progress in realisation of early diagnosis and treatment of patients with suspected rheumatoid arthritis: results from two matched questionnaires within three years.

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Practical progress in realisation of early diagnosis and treatment of

patients with suspected rheumatoid arthritis: results from two matched

questionnaires within three years.

Aletaha D, Eberl G, Nell VP, Machold KP, Smolen JS.

Division of Rheumatology, Department of Internal Medicine III, University of

Vienna, Austria.

BACKGROUND: Early diagnosis and treatment with disease modifying

antirheumatic drugs (DMARDs) have been advocated for patients with

rheumatoid arthritis (RA). This survey focuses on the individual definitions

and treatment modalities of rheumatologists, and aims at determining the

practical realisation of these concepts. METHODS: A questionnaire to be self

completed was handed out at the EULAR Symposium 1997. The main issues dealt

with were definition, referral time, diagnosis, follow up, and treatment of

early RA. Of the 111 participants, who were from all continents and all age

groups, 85 (77%) gave their name and address. In 2000, the same

questionnaire was sent to these 85 primary respondents. Forty four

questionnaires (52%) were returned, and their results were matched and

further evaluated. RESULTS: The definition of early RA was heterogeneous,

but two of three rheumatologists use the term " early " for symptoms shorter

than three months. There was a drift towards acceptance of involvement of

fewer affected joints. Serological tests obtained for early diagnosis were

mostly rheumatoid factor and antinuclear antibodies, usually in combination

(approximately 70%), while other tests (antikeratin antibodies,

antiperinuclear factor, anti-RA33) were used rarely, but increasingly

(21-25% all together). No significant change in the lag time of referral to

the specialist of patients with suspected early RA was seen within these

three years (<3 months for 50%, >6 months for 20%), while the proportion

followed up during the first three months increased. At both times, every

second rheumatologist started DMARD treatment only when the 1987 American

College of Rheumatology (ACR) criteria were fulfilled. However, in 1997

about 10% were willing to wait for erosions before starting DMARDs, while

none did so in 2000. Methotrexate, sulfasalazine, and antimalarial drugs

were the most commonly prescribed DMARDs in early RA, with the first two of

these still being in increasing use. CONCLUSION: The understanding of

" early " rheumatoid arthritis is heterogeneous, but the vast majority of the

rheumatologists surveyed regard symptom duration of <3 months as early.

Rheumatoid factor was the most useful laboratory support in early diagnosis.

Because there has been no shortening of referral time of patients with new

RA within the past three years, and many rheumatologists start DMARDs only

when the ACR criteria are fulfilled, it is concluded that guidelines for

early referral, as well as for early (rheumatoid) arthritis, are needed.

PMID: 12079906 [PubMed - indexed for MEDLINE]