Effectiveness of a clinical practice intervention in early rheumatoid arthritis

Abstract

Objective. To compare the outcome of early rheumatoid arthritis (RA) patients in a country where early clinics were established versus the outcome of patients in nonprotocolized clinics. Methods. We compared 2 multicenter cohorts: an RA cohort derived from an early arthritis registry set in 36 reference hospitals in which a specific intervention was established (Evaluation of a Model for Arthritis Care in Spain [SERAP]), and a historical control cohort of patients with early RA attending 34 rheumatology departments (Prognosis in Rheumatoid Arthritis [PROAR] cohort). Effectiveness was tested by comparing the change in the Disease Activity Score in 28 joints (DAS28), the change in the Health Assessment Questionnaire (HAQ), and the change in the Sharp/van der Heijde radiologic score using marginal structural models. Results. A total of 161 early RA patients were recruited in the PROAR cohort and 447 in the SERAP cohort. Being a SERAP patient was inversely correlated with activity, resulting in a decrease of ؊0.24 (95% confidence interval [95% CI] ؊0.39, ؊0.08) units in the population average of the DAS28 after adjustment was made. Moreover, intervention may be seen as a protective factor of radiologic damage, with a decrease of ؊0.05 (95% CI ؊0.09, ؊0.01) units in the logarithm of the total Sharp/van der Heijde score. On the other hand, a decrease in functional impairment was detected, but intervention was not statistically associated with HAQ changes. Conclusion. Preventing major radiographic progression in a 2-year term inside structured and organized special programs for the management of disease, such as early arthritis clinics, are effective compared to nonprotocolized referrals, treatment, and followup.

Impact of early diagnosis on functional disability in rheumatoid arthritis

“…Concerning the early diagnosis, a few previous studies have investigated the impact of early diagnosis on functional disability (Table 4) [8-11]. Two reported better outcomes for patients diagnosed early [8,10], whereas others found similar outcomes between the early diagnosis and delayed diagnosis groups [9,11].…”

“…Two reported better outcomes for patients diagnosed early [8,10], whereas others found similar outcomes between the early diagnosis and delayed diagnosis groups [9,11]. The patients examined in those studies were early RA patients who had never received DMARDs, and the numbers of patients investigated ranged from 40 to 608.…”

“…Two of these studies defined early diagnosis as a delay of less than 3 months from symptoms to diagnosis of RA [8,10]. The others classified patients into an early and a delayed treatment group according to the time between first visit and referral or referral and the start DMARDs [9,11]. The former pair of studies noted that HAQ scores improved more in the early diagnosis group and more patients in the early group achieved an HAQ score below 0.5 or 1.0 [8,10].…”

“…Although functional outcome is as important as disease activity and radiologic progression, only a few studies have investigated the influence of early treatment on functional outcome [8-11]. Moreover, these studies focused on patients with relatively short disease duration, between 1 to 3 years, and the effect of early diagnosis and treatment on functional outcome according to disease duration is not clear.…”

Artritis reumatoide a día de hoy

“…Por ello, en 2004, la Sociedad Española de Reumatología (SER) promovió, mediante el programa SERAP, el establecimiento de este tipo de consultas monográficas a lo largo de todo el país, estimulando que se aplicasen las estrategias T2T y TC y fomentando la colaboración con Atención Primaria. SERAP puso de manifiesto que, a pesar de las dificultades para su aplicación en la consulta diaria, dichas estrategias disminuían la destrucción articular en comparación con la práctica clínica realizada hasta entonces 18 .…”