OBJECTIVES: To study the delay in starting @entity627 ( @entity627 ) in @entity1 with @entity309 ( @entity309 ), and any changes in medical practice between 1980 and 1997. METHODS: 198 consecutive @entity309 @entity1 attending the rheumatology clinics at a teaching hospital, for routine review, had their case sheet reviewed. The dates of symptom onset, general practitioner (GP) referral, first clinic appointment and first use of DMARD were recorded. Data were collected on the erythrocyte sedimentation rate, C reactive protein, rheumatoid factor, and the presence/absence of erosions at the first clinic assessment. @entity1 were split into four groups according to the date of their first clinic assessment-before 1986, 1987-9, 1990-3, and 1994-7. RESULTS: There was a sharp drop in the delay between symptom onset and GP referral (before 1986, 21 months; 1987-89, 23 months; 1990-3, 7 months; 1994-7, 4 months, p<0.03), and in the delay between first assessment at the rheumatology clinic and the start of DMARD treatment (before 1986, 32 months; 1987-89, 21 months; 1990-1993, 8 months; 1994-7, 1 month, p<0.001). The number of @entity1 given DMARD treatment within six months of symptom onset increased from 5% (before 1994) to 44% (1994-7). Seventy three per cent of @entity1 waiting more than a year from symptom onset to first clinic appointment already had erosive change, compared with 34% of @entity1 seen within a year. CONCLUSIONS: @entity1 are being referred earlier in their disease, and @entity627 are prescribed sooner in the disease course. There has been a substantial increase in the proportion of @entity1 treated with a DMARD within six months of symptom onset.

Early referral, diagnosis, and treatment of XXXX : evidence for changing medical practice.

@entity1 :: ('9606', 'Species') :: ['Patients', 'patients'] @entity627 :: ('MESH:D012216', 'Disease') :: ['disease modifying anti-rheumatic drugs', 'DMARDs'] @entity309 :: ('MESH:D001172', 'Disease') :: ['rheumatoid arthritis', 'RA']
@entity309 :: (MESH:D001172,Disease) :: ['rheumatoid arthritis']
