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Rheumatology 2003; 42: 902-903
© 2003 British Society for Rheumatology
Letters to the Editor |
Outcome measures for rheumatologists
Department of Rheumatology, St Helens Hospital, Marshalls Cross Road, St Helens, Merseyside WA9 3DA, UK
SIR, Potter et al. [1] have highlighted a very important way by which we can assess our rheumatology service. This method incorporates evidence-based, clinically relevant targets. In line with all medical specialities, the British Society for Rheumatology (BSR) has submitted two clinical standards of patient care to the Royal College of Physicians Standards Committee. One of these standards relates to patients with suspected rheumatoid arthritis (RA) and reads ‘90% of patients with suspected diagnosis of rheumatoid arthritis should have access to specialist rheumatology services within three months of referral’ [2].
As rheumatologists, one of our primary aims in clinical practice is the early diagnosis and appropriate treatment of RA. There is compelling evidence that disease-modifying anti-rheumatic drugs (DMARDs) should be initiated within 3 months of onset of RA [3, 4]. Potter et al. give us the first glimpse of how this data may look in non-research situations. If we concentrate initially on secondary care, although 77% were seen within 12 weeks of a general practitioner referral, and two-thirds were seen within a month, only 63% of patients with RA received DMARDs within 3 months of this initial specialist assessment. Therefore, it is important to address the reasons for this delay of more than 3 months from initial assessment to the commencement of DMARD therapy in 37% of patients with RA. We need to look at the process by which patients assessed as having RA are then commenced on DMARD therapy. This delay may be due to a hospital system which requires a patient to come to a traditional follow-up clinic for review of investigations before discussing treatment options and commencing DMARDs. If this is the case, then we need to create an independent system which allows these patients to be fast-tracked until initiation of DMARD therapy.
Osteoarthritis and chronic pain syndromes make up the bulk of our new patient referrals, and chasing trust targets for new patient waiting times at the expense of targeting patients with recent onset inflammatory arthritis may lead to failure in the provision of care where it will make most difference to long-term outcomes.
As our representative society, the BSR should be setting targets that improve the outcome in RA. Surely we should be redefining our target for the assessment of a rheumatology service—from seeing patients with suspected RA within 3 months to not only seeing these patients but also initiating DMARD therapy within 3 months.
Notes
Correspondence to: J. K. Dawson. E-mail: twodocs{at}doctors.org.uk 
References
- Potter T, Mulherin D, Pugh M. Early intervention with disease-modifying therapy for rheumatoid arthritis: where do the delays occur? Rheumatology 2002;41:953–5.
[Free Full Text] - Palfreman TG, Clinical Affairs Committee. BSR Newsletter, November 2001.
- Quinn MA, Conaghan PG, Emery P. The therapeutic approach of early intervention for rheumatoid arthritis: what is the evidence? Rheumatology 2001;40:1211–20.
[Abstract/Free Full Text] - Hochberg MC. Early aggressive DMARD therapy: the key to slowing disease progression in rheumatoid arthritis. Scand J Rheumatol Suppl 1999;112:3–7.[Medline]
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