Long-term effectiveness of the Early Arthritis Recognition Clinic's screening for the presence of clinical arthritis in the Netherlands: a single-centre, longitudinal cohort study.

Abstract

General practitioner (GP) delay is the main cause of referral delay for rheumatoid arthritis in the Netherlands due to insufficient experience with joint examination. This delay led to the launch of the early arthritis recognition clinic, in which rheumatologists screen patients for clinical arthritis using joint examination. Because the long-term effectiveness of this intervention is unknown, we measured functional disability and sustained disease-modifying antirheumatic drug (DMARD)-free remission in patients with rheumatoid arthritis to establish its effectiveness. In this single-centre, longitudinal, comparative effectiveness cohort study, patients with rheumatoid arthritis who fulfilled the 1987 criteria, the 2010 criteria, or both of the American College of Rheumatology or European Alliance of Associations for Rheumatology and who were referred through the early arthritis recognition clinic (recruited between 2010 and 2020) were compared with similar patients with rheumatoid arthritis (at least one swollen joint and symptom duration of less than 2 years) referred through regular routes (recruited between 2006 and 2009). Both groups received similar treatment and follow-up for 5 years at the Leiden Early Arthritis Clinic. Outcomes were assessed in all patients. The long-term outcomes of Disease Activity Score (DAS) and functional disability-as measured by the Health Assessment Questionnaire-Disability Index (HAQ-DI)-were analysed by a linear mixed model, and the long-term outcome of sustained DMARD-free remission was analysed with Cox regression. Patients with lived experience of rheumatoid arthritis were involved in the study. Between Aug 31, 2010, and Jan 2, 2020, 2081 patients were seen via the early arthritis recognition clinic pathway, 818 patients had clinical arthritis and 132 patients with rheumatoid arthritis were eligible. 10 patients were lost to follow-up and 122 were included in the study (72 [59%] female and 50 [41%] male). Between Jan 5, 2006, and De 22, 2009, 690 patients were referred via the regular referral pathway with clinical arthritis of whom 342 had rheumatoid arthritis and were included in the study (225 [66%] female and 117 [34%] male. Patients referred via the early arthritis recognition clinic had lower disease activity (DAS-44) over 5 years (β=0·26 [95% CI 0·12-0·41]; p=0·0003), less functional disability (HAQ-DI) over 5 years (0·14 [0·02-0·25]; p=0·021), and higher rates of sustained DMARD-free remission (hazard ratio 2·1 [95% CI 1·34-3·16]; p=0·0010) compared with regularly referred patients. Patients with rheumatoid arthritis identified via the early arthritis recognition clinic had a lower median GP delay than regularly referred patients (median 5·14 weeks [IQR 1·86-11·43] vs 9·00 weeks [5·00-20·14], p<0·0001). Implementing an EARC screening clinic improved long-term outcomes and reduced referral delays in patients with rheumatoid arthritis. This study is one of the first to indicate that active intervention to accelerate diagnosis seems effective in improving long-term outcomes in patients with rheumatoid arthritis. The Dutch Arthritis Society.