A SYSTEMATIC LITERATURE REVIEW OF STRATEGIES FOR REDUCING DELAYS IN THE DIAGNOSIS AND MANAGEMENT OF EARLY INFLAMMATORY ARTHRITIS

Background: Despite the importance of timely management of patients with inflammatory arthritis (IA), delays still exist in its diagnosis and treatment. These may be seen at several levels –from time of symptom onset to primary care assessment, from primary care assessment to rheumatology referral, and from referral to rheumatology assessment. Objectives: A systematic literature review was performed to identify existing strategies addressing these delays, to inform an ACR/EULAR taskforce. Methods: We searched literature published between January 1985 and November 2010, and EULAR & ACR abstracts between 2007–2010. Additional information was obtained though a grey literature search and a survey conducted through ACR & EULAR to Rheumatologists. Results: We retrieved 44 articles, with 19 providing a comparator group enabling the assessment of efficacy. Twenty-five additional articles described potential systems to reduce referral delays. To address delays from patient at symptom onset to primary care, community case-finding strategies used a combination of questionnaires and autoantibody testing; analysis regarding optimal use and cost effectiveness is still under evaluation. Several internet websites were found, providing information of varying quality but this was generally insufficient to aid early referral. At a primary care level, several measures have been implemented to help identify patients with potential IA for referral to rheumatology including education programmes for GPs and health professionals. The use of patient self-administered questionnaires to detect IA within the primary care setting has reported sensitivities of 67-95% and specificities between 60-70%. Many referral guidelines emphasised the need for early referral; 2 provided specific elements to guide referral. Triage systems have been developed allowing prioritisation of patients, including those with suspected IA for early assessment. A triage clinic run by health professionals and GPs has also been implemented - sensitivity, specificity, PPV and NPV ranged between 87-92% in 1 study. Use of referral forms have been found to be beneficial in improving triage with reported sensitivities and specificities for IA between 77 - 97% and 55-76% respectively. To ensure timely rheumatology assessment once referred, early arthritis clinics have been developed in many centres. Wait times for patients presenting acutely with IA have also reduced with clinic reorganisation and development of rapid access systems. Conclusions: Several strategies have been developed to address delays in referral for patients with IA, from primary care to rheumatology referral and from referral to rheumatology assessment. Benefit has been reported within many different strategies, although not all have formally documented efficacy outcome measures. Case finding strategies for those at symptom onset are emerging but currently less well developed. Disclosure of Interest: None DeclaredCitation: Annals of the Rheumatic Diseases, volume 70, supplement 3, year 2011, page 197Session: Epidemiology, health services and outcome research (Poster Presentations )