Early referral to the rheumatologist for early arthritis patients: evidence for suboptimal care. Results from the ESPOIR cohort

Rheumatology (Oxford). 2010 Jan;49(1):147-55. doi: 10.1093/rheumatology/kep340. Epub 2009 Nov 23.


Objective: To assess the time to access a rheumatologist (TTAR) by early arthritis (EA) patients participating in a nationwide incidental cohort (ESPOIR) and compare it with European League Against Rheumatism (EULAR) recommendations, which recommends rapid referral, ideally within 6 weeks, to a rheumatologist for patients presenting with EA.

Methods: Eight hundred and thirteen patients with EA were included in the cohort between 2002 and 2005. The inclusion criteria were 18-70 years old, two or more swollen joints, symptom duration from 6 weeks to 6 months and possible RA diagnosis. TTAR was defined as the time between the first synovitis and first visit to a rheumatologist. TTAR and satisfaction of the EULAR guidelines were investigated by multiple linear and logistic regressions.

Results: Mean TTAR was 76 days; only 46.2% of patients were seen by a rheumatologist within the EULAR-recommended time frame. Patients' patterns of accessing medical care substantially affected access to specialized care: mean TTAR was 58 days for patients who directly scheduled an appointment with the rheumatologist and 78 days for those referred by their general practitioner (P < 0.0007). Only 57.2 and 44.5%, respectively, were able to consult a rheumatologist within 6 weeks. Multivariate analysis confirmed the significant impact of indirect access on TTAR, after adjustment for EA characteristics and medical density in the region.

Conclusions: Significant disparities were identified in the care of EA patients in terms of early access to a rheumatologist. More effort is needed to optimize the physicians' knowledge about EA and to improve the efficiency of medical networks.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Arthritis, Rheumatoid / diagnosis*
  • Arthritis, Rheumatoid / therapy
  • Clinical Competence
  • Early Diagnosis
  • Epidemiologic Methods
  • Family Practice / standards
  • Family Practice / statistics & numerical data
  • Female
  • France
  • Guideline Adherence
  • Health Services Research / methods
  • Humans
  • Male
  • Middle Aged
  • Practice Guidelines as Topic
  • Quality of Health Care*
  • Referral and Consultation / standards*
  • Referral and Consultation / statistics & numerical data
  • Time Factors
  • Young Adult