Importance of early detection and referral of rheumatoid arthritis

Harnden and colleagues highlight the importance of early detection and referral of rheumatoid arthritis.1 Serious delays in referrals and appointments were identified within the national rheumatoid arthritis and early inflammatory arthritis (EIA) audit’s first annual report.2

This audit assesses performance across England and Wales against National Institute for Health and Care Excellence (NICE) quality standards for rheumatoid arthritis.3 Data were collected on 6354 people from 97% of eligible trusts in the first 12 months of the audit.

NICE quality standard 1 recommends that patients presenting to primary care with new persistent (>3-4 weeks) synovitis are referred to rheumatology within three working days. Nationally, only 17% of patients were referred within this timescale. Achievement rates for this quality standard varied greatly across NHS regions (11% in the Midlands and East of England, 40% in Wales) and between trusts. The median delay between presentation and referral was 34 days. A quarter of patients waited more than three months for referral.

The audit also identified delays in attaining a specialist opinion once referral was initiated. Higher consultant numbers per head of population and the presence of EIA clinics were significantly associated with ability to see patients within three weeks of referral (NICE quality standard 2)—odds ratio 1.3 (95% CI 1.1 to 1.4) and 1.6 (1.4 to 1.7), respectively.

A key message from this audit is that once a clinical suspicion of inflammatory arthritis arises prompt referral to and assessment by rheumatology are warranted.