Earlier Visits More Likely to Result in Sustained DMARD-Free Remission for Patients With RA

Following recommendations to visit a rheumatologist within 6 weeks of symptom onset for patients with arthritis has benefits, but may not be necessary depending on the goal, according to results published in The Lancet Rheumatology.¹

Lead author Ellis Niemantsverdriet, PhD, of the Department of Rheumatology at the Leiden University Medical Center in Leiden, Netherlands, explained during a presentation² of the findings at the European Congress of Rheumatology of the European League Against Rheumatism (EULAR), that implementing the recommendation to be seen within 6 weeks “provides huge logistical challenges.”

“In addition, currently, there is no evidence that the first visit within 6 weeks leads to improved long-term outcomes compared with a first visit between 7 and 12 weeks,” she said. “And therefore, we investigated if time to encounter a rheumatologist within 6 weeks compared with 7 to 12 weeks results in better disease long-term outcomes.”

The study included 1539 patients with rheumatoid arthritis from the Leiden Early Arthritis Clinic (n = 1025; between January 1, 1996, and December 31, 2017) and the French Etude et Suivi des Polyarthrites Indifferenciées Recentes (n = 514; between November 1, 2002, and April 30, 2005). The patients were grouped based on the time from symptom onset and first visit with a rheumatologist: within 6 weeks (EULAR recommendation), between 7 and 12 weeks, and after 12 weeks.

After 7 years, 24% (30 of 127) of patients in the Leiden Early Arthritis Clinic who visited a rheumatologist within 6 weeks, 20% (45 of 223) with a visit between 7 and 12 weeks, and 15% (100 of 675) with a visit after 12 weeks achieved sustained disease-modifying antirheumatic drug (DMARD)-free remission. After 10 years of follow-up in the French Etude et Suivi des Polyarthrites Indifferenciées Recentes, 27% (3 of 11) of patients with a visit of 6 weeks or less after symptom onset, 11% (11 of 100) with a visit between 7 and 12 weeks, and 10% (41 of 403) with a visit after 12 weeks had sustained DMARD-free remission.

A multivariable analysis found that patients had similar radiographic progression regardless of if they saw a rheumatologist within 6 weeks, between 7 and 12 weeks, or after 12 weeks.

The authors concluded that deciding whether or not to implement the recommendation to see a rheumatologist within 6 weeks of symptom onset “might depend on the long-term treatment aim.” Since sticking to that timeline did have a beneficial effect on “sustained DMARD-free remission,” but the timeline is not necessary to minimize structural damage.

“Since clinically relevant joint destruction has become infrequent and sustained DMARD-free remission is increasingly achievable, achieving a time to encounter within 6 weeks, although challenging, might become of increasing importance,” the authors concluded.

References

1. Niemantsverdriet E, Dougados M, Combe B, van der Helm-van Mil, AHM. Referring early arthritis patients within 6 weeks versus 12 weeks after symptom onset: an observational cohort study. Lancet Rheumatol. 2020;2(6):e332-338. doi:10.1016/S2665-9913(20)30061-8

2. Niemantsverdriet E, Dougados M, Combe B, van der Helm-van Mil, AHM. Is referring early arthritis patients within 6 weeks associated with better long-term outcomes than referring within 12 weeks after symptom onset? — investigating the evidence for the first EULAR recommendation for early arthritis in two observational cohorts. Presented at: EULAR 2020; June 3-6, 2020; Abstract OP0222.