Early Referral and Outcome in Rheumatoid Arthritis

Abstract

In a cross-sectional study of 200 outpatients with rheumatoid arthritis (RA) we tested the hypothesis that early specialist referral within one year of disease onset reduces subsequent functional disability. Early referral was defined as being seen in a specialist unit within one year of the onset of symptoms. Functional outcome was measured using the physical functional section of the full test (NHP) and (HAQ). Additional information was collected on other factors likely to influence disability including age, sex, pain scores, and rheumatoid factor positivity. The difference in average HAQ and NHP physical function scores between late and early referrals was 0.34 and 11.0 respectively (p<0.01 in both cases) using unequal-variance t-test. After adjusting for the other risk factors, multiple regression analysis showed late referral patients had greater NHP physical function scores than early-referred patients by approximately 8 points and there was a similar trend with HAQ. We conclude that early referral for specialist advice is associated with improved health status, with reduced physical function scores on the NHP.