Time to Treatment in Rheumatoid Arthritis Factors Associated With Time to Treatment Initiation and Urgent Triage Assessment of General Practitioner Referrals

Background: The importance of early diagnosis and treatment of rheumatoid arthritis (RA) is increasingly being recognized. This requires accurate triaging of suspected RA referrals from primary care and expedient assessment of these patients in secondary care. Objectives: To assess the factors associated with urgent triage for first specialist appointment and early disease modifying agents in rheumatic disease treatment. Methods: The general practitioner (GP) referrals to a single rheumatology service from 128 new RA patients were assessed for their information content and triage allocation by the Rheumatologists. Information on symptoms, signs, and investigation results were collected. Factors associated with urgent triage allocation, time to treatment, and a GP requesting urgency were assessed. Results: Median time from symptom onset to treatment was 6.1 months. Triage allocation to urgent was associated with earlier treatment (difference of 97 days, P = 0.003). GP perception of urgency (odds ratio = 13.34, 95% confidence interval: 2.20-81.02) was independently associated with an urgent triage allocation by the triaging rheumatologist. Swollen joints and a raised C-reactive protein predicted GP request for urgency. Conclusion: Triage is important to facilitate early treatment; however, rheumatologists in this service are not currently triaging suspected RA referrals with reference to known poor prognostic indicators. Several interventions could improve both informative referrals and triaging of referrals to decrease time to diagnosis and treatment. These interventions could include public education, GP education sessions with associated distribution of referral guidelines, and reminding triaging rheumatology clinicians about the available prognostic factors often present in GP referrals that assist with correct triage.