Rheumatoid arthritis: see a specialist early
14 June 2001
| A new global initiative, named CARE (Collaboration to Assess and Refer Early), could help GPs to detect rheumatoid arthritis (RA) early and help them make the decision to refer people with RA to a rheumatologist quickly.
This means that people with RA could receive appropriate treatment early in the progression of the disease, resulting in a better outlook in the long-term. |
Prague, Czech Republic, was the setting for the 2001 congress of the European League Against Rheumatism. |
Professor Paul Emery, Head of Rheumatology and Rehabilitation Research at the University of Leeds in the UK, and chair of the CARE initiative, said: ‘There is a definite need for physicians to identify rheumatoid arthritis early, since we know the greatest amount of structural damage occurs within the first 2 years of disease onset, leading to disability.’
About 75 per cent of people with early RA develop joint erosions (damage to the structure of the joints) within 2 years of the start of their symptoms. Given that up to 50 per cent of people with RA are unable to work 10 years after diagnosis, early diagnosis and appropriate treatment are vital, according to Professor Emery.
However, delays—first caused by the person with RA taking too long before seeing their general practitioner (GP) in the first place, and then by the delay in diagnosing RA (it is hard to diagnose in the early stages) and subsequent referral to a rheumatologist—mean that people with RA are often not being treated as quickly as they should be.
The CARE initiative gives GPs some simple guidelines to help them decide if they should refer a patient to a rheumatologist for further assessment and treatment of rheumatoid arthritis.
The recommendation for GPs states that rapid referral to a rheumatologist is necessary if any of the following are present:
- 3 or more swollen joints;
- certain swollen hand joints (which the doctor can check by conducting a ‘squeeze test’ on the relevant joints); and/or
- morning stiffness that lasts for 30 minutes or longer.
Professor Emery discussed the early referral recommendation at EULAR 2001, the annual congress of the European League Against Rheumatism, held in Prague, Czech Republic, from June 13 to 16.
He said: ‘Physicians need to recognise that early referral to a rheumatologist within the first 12 weeks of onset of symptoms, and treatment with a disease-modifying anti-rheumatic drug, improves long-term outcomes for patients.’
Disease-modifying anti-rheumatic drugs (DMARDs) are sometimes also known as slow-acting anti-rheumatic drugs (SAARDs). There are several types available: some examples include methotrexate (Ledertrexate, Methoblastin), sulfasalazine (Pyralin EN, Salazopyrin EN), or leflunomide (Arava).
DMARDs work by slowing down joint erosion, although the exact mechanism of how they work largely remains unknown. Their effectiveness is often judged by their ability to slow the progression of erosions as measured on X-rays.
‘RA 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 their quality of life,’ said Professor Emery.
Last Reviewed: 28 June 2001
- Emery P et al. Rheumatology and Rehabilitation, University of Leeds, School of Medicine. Development of an evidence-based referral recommendation for the optimum DMARD treatment of patients with early stage rheumatoid arthritis.
