Patients with suspected rheumatoid arthritis should be referred early to rheumatology

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