[Early referral and treatment of patients with acute arthritis. Experiences from two early arthritis clinics].
BACKGROUND
Our aim was to describe the referral pattern among patients admitted to early arthritis clinics (EAC) in the counties of Funen and South Jutland, Denmark.


METHODS
In order to accelerate the diagnostic workup of patients with suspected rheumatoid arthritis (RA), general practitioners, rheumatology specialists and neighbouring hospital departments were invited to refer to the EAC patients who had synovitis in at least one joint lasting more than 6 weeks but less than 12 months.


RESULTS
226 patients were admitted. The median total lag time from onset of joint complaints to visiting the EAC was 89 days (IQ 57-154). The average lag time between receipt of the referral to the first visit to the EAC was 18 days (IQ 5-31). 91 (40%) of the patients had synovitis upon clinical examination. 51 (23%) of these fulfilled the ACR 1987 classification criteria for RA, and 40 (17%) had synovitis of other aetiologies than RA. Compared with non-RA patients, the RA subset was characterised by older age, female preponderance, higher joint counts and disability and a more pronounced acute phase response. Despite the short duration of the disease, 17% of the RA patients had X-ray erosions.


CONCLUSIONS
In spite of the rigid criteria for referral to the EAC, synovitis was demonstrated by clinical examination in only 40% of the patients. Half of these were classified as RA. The total median lag time of three months from the onset of joint symptoms to the first visit to the EAC accords with current recommendations. Standardised criteria for referral to EACs should be prepared and combined with educational efforts to improve joint assessment skills.
Lindegaard
Hanne Merete
HM
Odense Universitetshospital, Medicinsk Afdeling C, Reumatologisk Sektion, Odense C. lindegaard@dadlnet.dk
Hørslev-Petersen
Kim
K
Junker
Peter
P
D000208:Acute Disease; D000328:Adult; D000368:Aged; D018501:Antirheumatic Agents / Q000008:administration & dosage; D001168:Arthritis / Q000175:diagnosis* / Q000188:drug therapy; D001172:Arthritis, Rheumatoid / Q000175:diagnosis* / Q000188:drug therapy; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage; D008875:Middle Aged; D012017:Referral and Consultation; D013585:Synovitis / Q000175:diagnosis* / Q000188:drug therapy; D013997:Time Factors
D018501:Antirheumatic Agents; D008727:Methotrexate