Practical progress in realisation of early diagnosis and treatment of patients with suspected RA

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Ann Rheum Dis 2002 Jul;61(7):630-4

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, Vienna, Austria Second Department of Medicine,

Lainz Hospital, Vienna, Austria Ludwig Boltzmann Institute for

Rheumatology, 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