Late referral of patients with rheumatoid arthritis to rheumatologists

Summary

One possible reason for advanced disability occurring in patients with rheumatoid arthritis (RA) is late referral to specialist rheumatology departments. To determine the extent of late referral in RA, associated clinical features, and reasons for its occurrence, 50 successive patients newly referred to two rheumatology departments in Dublin and London were studied and compared.Clinical features of disease activity and severity were similar in both groups.Thirteen patients, 12 female, were identified who had developed RA more than 10 years before their first specialist referral. In seeking to explain this phenomenon, geographic, social and clinical factors were examined. Late referral was not associated with distance from specialist centres, older age at onset, or milder disease forms. Eleven of the 13 patients lived within 10 miles of the relevant rheumatology department. Considerable joint destruction and disability was present, but only 4 had previously received specific disease remittive agents. In conclusion, late specialist referral of patients with RA occurred with equal frequency in both centres. This phenomenon is probably more widespread and contributes to unnecessary disability in RA.