A comparison of disease status in rheumatoid arthritis patients attending and not attending a specialist clinic.
Newman J., Silman AJ.
The objective was to test the hypothesis that rheumatoid arthritis (RA) patients currently not receiving specialist care have milder and less active disease than clinic attenders. The subjects were recruited from a media campaign aimed at identifying RA patients for a nationwide twin study. All subjects were interviewed at home and examined. Data from serological and radiological investigations were obtained. Data were also obtained about any specialist care, including the date, where relevant, of the most recent hospital appointment. For subjects reporting ever attending a specialist clinic, the current status (discharged/under current care) and the date of their most recent appointment were verified from hospital records. Data from 149 patients were analysed, of whom 114 (76%) were current hospital clinic attenders at the time of interview, 10 (7%) had never attended and 25 (17%) were ex-attenders. There was a similar proportion with current morning stiffness (> 1 h) in all three groups (60%). The median number of (i) swollen (S) joints, (ii) tender (T) joints and (iii) swollen and tender (ST) joints was almost identical-current attenders: (S) 7, (T) 9, (ST) 11; ex-attenders: (S) 5, (T) 8, (ST) 10; never attenders: (S) 7, (T) 14, (ST) 17. There were similar proportions with radiological erosions in the current and ex-attenders (79 and 72%, respectively). Current attenders were, however, substantially more likely to be taking disease-modifying drugs. In these volunteer patients, those currently managed entirely in primary care did not have less severe or active disease.