For people with rheumatoid arthritis (RA) early consultation with a rheumatologist can help prevent surgery down the road, according to a study presented at the American College of Rheumatology 2011 meeting in Chicago. People who consulted a rheumatologist within three months of being diagnosed with RA were about 40 percent less likely to have orthopaedic surgery compared with people who waited longer than that to see a rheumatologist.
“Our findings suggest that if you have RA and are under the care of a rheumatologist, you are more likely to get appropriate treatment,” says lead author Debbie Feldman, PhD, professor in the school of rehabilitation at the University of Montreal, Canada. “This is important information for primary care doctors, who are often the ones who diagnose RA, as well as for patients. Patients should be referred for early consultation with a rheumatologist.”
The study looked at 3,890 patients from the Province of Quebec who diagnosed with RA between the years 1995 to 2007. The average age at diagnosis was about 56 years, and about 70 percent of all patients were women.
Patients were classified as “early consulters” if they were seen by a rheumatologist within three months of an RA diagnosis by their primary care provider. They were classified as “late consulters” if they were seen by a rheumatologist more than three months after their initial diagnosis. (Late consulters saw a rheumatologist on average 12 to 18 months after diagnosis, says Dr. Feldman.) If they were diagnosed by a rheumatologist, they were classified as “undetermined.”
Over the 12-year period from 1995 to 2007, 16 percent of all the patients had orthopaedic surgery, including 24 percent of the late consulters, 17 percent of the early consulters and 14 percent of the undetermined patients (who presumably got appropriate treatment immediately, since there was no lag time between RA diagnosis and seeing a rheumatologist).
“This study has policy implications, as well as implications for individual patients. Surgery is costly, and early treatment by a rheumatologist can save the health care system money as well as spare patients from having surgery,” Dr. Feldman says. “Our results support early treatment of RA guided by a rheumatologist.”
“Other studies have also shown that patients do better when treated by a rheumatologist [rather than a general practitioner],” says Joanne Jordan, MD, director of the Thurston Arthritis Research Center at the University of North Carolina, Chapel Hill, who moderated a press conference where these results were discussed.
Eric Matteson, MD, chair of the division of rheumatology at the Mayo Clinic in Rochester, Minn., agrees. “When you see a rheumatologist early after diagnosis, you get started on appropriate therapy, and that stops the progression of joint damage to the point where it is so severe that you need surgery.”