31 January 2019
Arthritis is common worldwide and is associated with significantly impaired quality of life and disability. So far, 207 types of arthritides have been identified highlighting the diagnostic challenge for patients and health care professionals. Rheumatoid arthritis (RA) is one of the most common types of arthritis affecting 1% of the population. The condition affects approximately three times more women than men and its onset is generally in the 5th and 6th decades however it may occur at any age. Uncontrolled RA leads to significantly reduced quality of life and premature mortality primarily as a consequence of increased cardiovascular disease.
However, the outlook for patients has altered dramatically over the past few years with disease remission now the therapeutic goal. This is dependent on a number of critical interventions and the role of our patients is pivotal in the process. Without early recognition and rapid referral, the ability to achieve the desired outcome of disease remission would be greatly hindered.
There is a ‘window of opportunity’ for people diagnosed with RA. Those diagnosed and started on optimal treatment within 12 weeks stand a much better chance of achieving remission. However we know that many people with RA are not being diagnosed and treated in time.
Poor public awareness and a lack of timely referral are causing significant delays. Research shows that people with symptoms of RA usually wait a number of months before first going to see their GP and then visit their GP several more times before being referred on to a specialist for diagnosis.
Following presentation to primary care, patients with symptoms and signs of an inflammatory arthritis should be referred to a rheumatologist. This imperative has been highlighted in the NICE guideline on the treatment of RA. The guideline recommends that any patient with suspected persistent synovitis of undetermined cause should be referred for specialist opinion and suggests urgent referral if any of the following apply:
- The small joints of the hands or feet are affected
- Less than 1 joint is affected
- There has been a delay of more than 3 months between onset of symptoms and seeking medical advice
The basis for this advice lies in the observation that early disease is more amenable to intervention. A window of opportunity exists whereby early treatment results in a greater chance of inducing remission. Ideally, this should be within six weeks of symptom onset. As a proportion of patients who develop severe persistent inflammatory arthritis will have normal investigations at disease onset (e.g. rheumatoid factor, anti- CCP antibodies, ESR, CRP and X-rays) they should be referred regardless. Similarly, the referral should not be delayed pending investigations.
This article has been written for you by Dr Muhammed Nisar, Consultant Rheumatologist and Physician practising here at Spire Harpenden Hospital. Follow his expert advice, if you feel you may have any of the above symptoms please seek urgent medical attention, don’t delay! Call our friendly self-pay team today to arrange a consultation: 01582 714 420