Practice Change Page

Patients with suspected rheumatoid arthritis should be referred early to rheumatology

BMJ 2008; 336 doi: http://dx.doi.org/10.1136/bmj.39381.597454.AE (Published 24 January 2008) Cite this as: BMJ 2008;336:215
  1. Kimme L Hyrich, clinical lecturer and consultant in rheumatology1
  1. 1ARC Epidemiology Unit, University of Manchester, Manchester M13 9PT
  1. kimme.hyrich{at}manchester.ac.uk

    Key points

    • Early treatment of rheumatoid arthritis results in better long term outcomes

    • Patients with suspected rheumatoid arthritis should start treatment with disease modifying anti-rheumatic drugs (DMARDs) as soon as possible, ideally within three months of onset

    • Most patients with rheumatoid arthritis do not receive DMARD treatment within three months of onset

    • Delay is probably due to a combination of patient related and physician related factors

    The clinical problem

    Rheumatoid arthritis affects 1% of adults and is associated with progressive joint damage and disability and increased mortality. Treatment with disease modifying anti-rheumatic drugs (DMARDs), such as methotrexate, has been shown to reduce the progression of radiologically evident joint damage and improve long term disability. A shift towards starting DMARD treatment as early as possible has therefore occurred. Guidelines recommend that patients should be referred early, ideally within six weeks of the onset of symptoms,1 and that DMARDs should be started within 12 weeks of onset.2 However, a recent survey found that only 50% of patients were assessed by a rheumatologist within this time.3 I propose that patients with suspected rheumatoid arthritis should be referred to rheumatology as soon after first presentation as possible.

    Evidence for change

    Benefits of early treatment:

    A …

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