RESEARCH - Early referral to the rheumatologist for early arthritis patients: evidence for suboptimal care: ESPOIR

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Rheumatology Advance Access published online on November 23, 2009

Rheumatology, doi:10.1093/rheumatology/kep340

Early referral to the rheumatologist for early arthritis patients:

evidence for suboptimal care. Results from the ESPOIR cohort

Bruno Fautrel1,2, Mathilde Benhamou1,2, Violaine Foltz1,2, Nathalie

Rincheval3, Anne- Rat4,5, Bernard Combe6, Francis

Berenbaum7,8, Pierre Bourgeois1,2 and Francis Guillemin4,5

1APHP, Groupe Hospitalier Pitié-Salpêtrière, Service de Rhumatologie,

2Université Pierre et Marie Curie – Paris VI, UFR de médecine, Paris,

3Université Montpellier 1, UFR de Médecine, Institut Universitaire de

Recherche Clinique, Montpellier, 4 Université, EA 4360 APEMAC,

Ecole de Santé Publique, Faculté de Médecine de , 5INSERM, CHU de

, CIC-EC Centre D’épidémiologie Clinique, , 6Centre

Hospitalo-Universitaire du Montpellier, Hôpital Lapeyronie, Service de

Rhumatologie, Montpellier, 7APHP, Hôpital Saint Antoine, Service de

Rhumatologie and 8Université Pierre et Marie Curie – Paris VI, UFR de

médecine, Paris, France.

Abstract

Objective. To assess the time to access a rheumatologist (TTAR) by

early arthritis (EA) patients participating in a nationwide incidental

cohort (ESPOIR) and compare it with European League Against Rheumatism

(EULAR) recommendations, which recommends rapid referral, ideally

within 6 weeks, to a rheumatologist for patients presenting with EA.

Methods. Eight hundred and thirteen patients with EA were included in

the cohort between 2002 and 2005. The inclusion criteria were 18–70

years old, two or more swollen joints, symptom duration from 6 weeks

to 6 months and possible RA diagnosis. TTAR was defined as the time

between the first synovitis and first visit to a rheumatologist. TTAR

and satisfaction of the EULAR guidelines were investigated by multiple

linear and logistic regressions.

Results. Mean TTAR was 76 days; only 46.2% of patients were seen by a

rheumatologist within the EULAR-recommended time frame. Patients’

patterns of accessing medical care substantially affected access to

specialized care: mean TTAR was 58 days for patients who directly

scheduled an appointment with the rheumatologist and 78 days for those

referred by their general practitioner (P < 0.0007). Only 57.2 and

44.5%, respectively, were able to consult a rheumatologist within 6

weeks. Multivariate analysis confirmed the significant impact of

indirect access on TTAR, after adjustment for EA characteristics and

medical density in the region.

Conclusions. Significant disparities were identified in the care of EA

patients in terms of early access to a rheumatologist. More effort is

needed to optimize the physicians’ knowledge about EA and to improve

the efficiency of medical networks.

http://rheumatology.oxfordjournals.org/cgi/content/abstract/kep340v1?papetoc

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