FRI0633 How do we implement the eular recommendation that rheumatologists can see early arthritis patients within six weeks after symptom onset? a five-year comparative study of an early arthritis recognition clinic.
Authors: R. M. Ten Brinck, B. T. van Dijk, H. W. van Steenbergen, A. H. van der Helm-van Mil
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background:</h3> Early treatment of inflammatory arthritis (IA) associates with improved outcomes. Therefore, the first recommendation in the 2016 update of the EULAR guidelines for management of early IA states that patients presenting with IA should be seen by a rheumatologist ≤6 weeks. Data on how to implement this recommendation are lacking. A screening clinic situated in between primary and secondary care, the Early Arthritis <i>Recognition</i> Clinic (EA<i>R</i>C), has previously shown to increase early identification of rheumatoid arthritis patients. However, it is unknown if this effect is sustained when applied for several years and if this approach is of added value to identify patients within the 6-week limit set by EULAR. <h3>Objectives:</h3> To study if an EA<i>R</i>C approach can lead to sustained early identification of patients with IA (as compared to regular referral to our Early Arthritis Clinic (EAC)) and to determine the efficacy to identify patients ≤6 weeks after symptom onset. <h3>Methods:</h3> To promote early recognition of IA, the EA<i>R</i>C was initiated in September 2010 in the Netherlands. General practitioners (GPs) were instructed to refer to this screening clinic without a scheduled appointment if they were unsure about the presence of IA (instead of a 'wait-and-see' approach or performing additional tests). At the EA<i>R</i>C, patients were seen for a 5-minute visit by an experienced rheumatologist who performed a full 66-joint examination for clinical synovitis. GPs can also refer directly to the EAC, where patients are seen &lt;2 weeks' time. Thus, GPs in our region can refer directly for a full visit in secondary care, or to a short visit to a screening clinic that is situated in between primary and secondary care. Patients identified with IA at the EA<i>R</i>C or after (direct) referral to the EAC between September 2010 and December 2014 were compared for symptom duration at IA identification. <h3>Results:</h3> Of the 1,151 patients visiting the EA<i>R</i>C, 475 (41%) were diagnosed with IA. Firstly, proportions of patients with IA at the EA<i>R</i>C were studied per year. These remained stable over time: 45% in 2010, 39% in 2011, 45% in 2012, 42% in 2013 and 36% in 2014. Clinical characteristics of these patients were similar over time. In the same period 675 referred patients were diagnosed with IA at the EAC; these were compared to the 475 IA patients that were identified via the EA<i>R</i>C. Demographic characteristics were similar. However, median symptom duration of the IA patients in the EA<i>R</i>C-group versus the EAC-group at identification of IA were 10.7 vs 17.0 weeks in 2010 (p&lt;0.0001), 7.3 vs 13.7 weeks in 2011 (p=0.0001), 6.3 vs 9.8 weeks in 2012 (p=0.056), 5.6 vs 10.7 weeks in 2013 (p=0.012) and 5.7 vs 8.3 weeks in 2014 (p=0.060). Proportions of patients with IA seen by a rheumatologist ≤6 weeks in the EA<i>R</i>C-group versus the EAC-group were: 34% vs 19% in 2010, 43% vs 20% in 2011, 43% vs 33% in 2012, 48% vs 30% in 2013 and 44% vs 33% in 2014. <h3>Conclusions:</h3> A screening clinic in between primary and secondary care has sustainable benefit with regards to early identification of inflammatory arthritis and allows &gt;40% of patients to be identified within the timelines as recommended by EULAR. <h3>Disclosure of Interest:</h3> None declared