Delays in the specialist assessment of patients with suspected rheumatoid arthritis (RA) are “unacceptably long,” finds a study carried out in eight European countries led by the University of Birmingham, published online today in the Annals of the Rheumatic Diseases.

The average delay between start of symptoms to assessment by a rheumatologist was 24 weeks, with the percentage of people seen within 12 weeks varying between centres from 8% to 42%.

The first three months after the start of rheumatoid symptoms are important for making sure that treatment has the best chance of working to slow progression, say the authors.

They looked at the contribution of patient and professional behaviours and health systems to delays in the assessment of patients with rheumatoid arthritis in 482 people attending 10 specialist rheumatology centres in eight European countries in 2009/10.

These included centres in: Birmingham in the UK; Prague in the Czech Republic; Warsaw in Poland; Vienna in Austria; Berlin in Germany; Heraklion in Greece; Stockholm, Lund and Umea in Sweden; and Zurich in Switzerland.

They looked at four levels of delay: how long it took before patients made a request to see a healthcare professional about their symptoms; how long it then took that professional to see the patient; how long it then took the healthcare professional to make a referral to a rheumatologist; and how long it took before the rheumatologist then saw the patient.

The contributions of the individual components of delay to total delay varied between centres. Consistent with previous work, patients in the UK waited on average 12 weeks before seeing their GP. In Heraklion, patients waited even longer before seeking help from a health care professional (average 22 weeks) whilst in Berlin and Vienna patients saw a health care professional within an average of 2 weeks.

There were also significant variations between delays at the other three levels studied:
• how long it took the initial health professional to see the patient once the patient requested to see them varied from an average of 1 to 12 weeks.
• how long it then took before a referral to a rheumatologist was made varied from an average of 2 to 12 weeks.
• how long it then took for the rheumatologist to see the patient varied from an average of 1 to 11 weeks.

The authors referred to work from the UK’s National Audit Office which calculated that doubling the proportion of RA patients treated with disease modifying drugs within three months of symptom onset from a current (estimate of) 10% to 20% may increase costs to the NHS by £11 million over 5 years. However, over the same period, productivity gains for the UK alone of around £31 million could be expected – in addition to increasing quality of life for patients.

Dr Karim Raza, rheumatologist from the University of Birmingham’s College of Medical and Dental Sciences said: ‘Across Europe, delays in the assessment of patients with rheumatoid arthritis by rheumatologists are too long. As highlighted in a recent report from the UK National Audit Office, tackling this should represent a priority for strategies to improve patient outcomes.’


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