AB1227 PREFERRED REFERRAL PROTOCOL FOR RECENT ONSET ARTHRITIS IN ADULTS FROM PRIMARY CARE TO RHEUMATOLOGY
Authors: Consuelo Ramos Giráldez, María Espinosa, Carolina Merino Argumánez, Patricia Fernández Crespo, Olga Rusinovich, Fernando León Vázquez, José Luis Andreu Sánchez, Carmen Barbadillo Mateos
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background:</h3> The time of rheumatoid arthritis (RA) evolution until treatment begins is key to controlling the disease. Many studies have shown that a prolonged duration of symptoms at the onset of treatment is associated with a more severe course of RA. The time from symptoms onset to first DMARD prescription is &gt;12 weeks in Spain, because of diagnostic delay due to either patient-related factors (delay in consultation), Primary Care Physician (PCP) (delay in citation/referral) or rheumatologist (delay in citation). <h3>Objectives:</h3> To evaluate the usefulness of teleconsulting as a preferred referral tool from PCP to Rheumatology for early detection, diagnosis and treatment of inflammatory joint disease in adults, in the health area of a tertiary hospital. <h3>Methods:</h3> A preferential referral circuit was established between the PCP and the Rheumatology Service of a tertiary hospital, defining the referral criteria as "patient suspected of recent onset arthritis (ROA)": arthritis or inflammatory arthralgia in &gt;1 peripheral joint for &gt;2 weeks with neither traumatic cause nor previous diagnosis of rheumatic disease. PCP performed first assessment, the request for initial tests (blood test including acute phase reactants, rheumatoid factor ± ANA, elemental urine and hands radiography) as well as the referral to Rheumatology with "ROA suspicion" motive. These consultation requests were cited from the Rheumatology Service within &lt;15 days of receipt. Before the protocol was established, its functioning was communicated as a face-to-face clinical session: by 2 rheumatologists in a Health Centre (HC) and by 1 PCP in the rest of the HC in the area. A poster was edited and published, exposing criteria and referral method for PCP's offices. <h3>Results:</h3> During the first 6 months 33 patients were correctly referred. 78.8% were women and the average age was 49 years old. 48.8% (16 patients) were diagnosed with some inflammatory arthropathy: 31.5% were RA (5 cases); other diagnoses were arthropathy due to microcrystals deposit (2), overlap SLE/RA (1), MCTD(1), psoriatic arthritis (1), spondyloarthritis associated with IBD (1) or inflammatory arthralgia associated with retroperitoneal fibrosis (1). 12% (4 patients) were diagnosed with hands incipient osteoarthritis and 33.8% (12 patients) with arthralgias without data on inflammatory pathology. One patient missed her follow-up. The median time from symptom onset to Rheumatology assessment was 90 days in all patients; in the inflammatory pathologies subgroup, 68.8% was assessed in &lt;12 weeks, with a median of 60 days and a mean of 96 days, starting treatment in this subgroup in the first assessment by Rheumatology. <h3>Conclusion:</h3> In our experience, the establishment of a specific protocol in collaboration with Primary Care for the preferential referral of patients with suspected recent onset arthritis, obtained diagnoses not only for patients with rheumatoid arthritis, but also for other systemic autoimmune diseases in early stages, as well as early treatment initiation (&lt;12 weeks) in most of these patients. In addition, it turned out to be an effective and comfortable referral route for PCP with suspected connective and/or inflammatory arthritis. <h3> Disclosure of Interests:</h3> Consuelo Ramos Giráldez Speakers bureau: Sanofi, María Espinosa: None declared, Carolina Merino Argumánez: None declared, Patricia Fernández Crespo: None declared, Olga Rusinovich: None declared, Fernando León Vázquez: None declared, José Luis Andreu Sánchez: None declared, Carmen Barbadillo Mateos: None declared