Rheumatology 2003; 42: 903
© 2003 British Society for Rheumatology
Letters to the Editor |
Reply
Birmingham Heartlands and Solihull NHS Trust (teaching), Rheumatology, Birmingham, W. Midlands and 1Cannock Chase Hospital, Rheumatology, Cannock, Staffordshire, UK
We appreciate the interest of Kaushik et al. [1], and share the importance they attach to commencing disease-modifying therapy in appropriate patients as quickly as possible following onset of rheumatoid arthritis (RA) [1]. Indeed, it was the delay in this process, highlighted by our previous audit, which prompted the current work. We agree that the current political imperative to reduce waiting time to first consultation distorts clinical practice as one becomes so busy seeing new patients that one never has the time to initiate treatment and review progress. However, we feel it is an inappropriate standard to expect to commence all patients with RA on disease-modifying therapy within 3 months of their first rheumatology clinic appointment.
Our data demonstrated that 20 patients, representing 26% of the total group, waited longer than 3 months to commence disease-modifying therapy following the initial clinic visit. Of these, six had required further medical investigation prior to commencing therapy, five were initially mild cases which did not require therapy, four declined disease-modifying therapy initially, two appeared to have polymyalgia rheumatica and single patients had delayed therapy because of an atypical presentation, a good initial response to prednisolone or a deferred clinic appointment. Before setting treatment targets, it must be remembered that there can be difficulties in making a reliable diagnosis of early RA and not everyone with RA may need or want disease-modifying therapy. Having said that, we agree that there is real scope for the BSR to set challenging standards to cover all aspects of our care for rheumatology patients, similar to the work of the Scottish Inter-collegiate Guideline Network at www.sign.ac.uk.
Notes
Correspondence to: M. Pugh. E-mail: mark.pugh{at}heartsol.wmids.nhs.uk 
References
- Kaushik VV, Abernethy VE, Lynch MP, Dawson JK. Outcome measures for rheumatologists. Rheumatology 2003;42:000–000.
- Jeyaratnam R, Kerr LD, Speira H, Crane RP, Pugh MT. A comparative analysis of the time taken from onset of symptoms of rheumatoid arthritis to initiation of disease modifying antirheumatic drugs at the Mount Sinai Hospital, USA and the Birmingham Heartlands Hospital, UK. Rheumatology 2001;40(Suppl. 1):29.
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