A study of eight European countries published online in the Annals of the Rheumatic Diseases reports that the delays in specialist assessment of patients with suspected rheumatoid arthritis are "unacceptably long". From the start of symptoms to assessment by a rheumatologist the average delay amounted to 24 weeks. The percentage of people seen within 12 weeks of their initial symptoms varied from 8% to 42% between centers.

The authors point out, that the first three months following the start of rheumatoid symptoms are crucial to ensure that treatment has the optimum chance of working to slow progression.

Researchers evaluated 482 people with rheumatoid arthritis who attended 10 specialist rheumatology centers in eight European countries in 2009/10, comparing the contribution of patient and professional behaviors and health systems to delays in the assessment of patients.

The health centres were located in Birmingham in the UK; Prague in the Czech Republic; Warsaw in Poland; Vienna in Austria; Berlin in Germany; Heraklion in Greece; Stockholm, Lund and Umea in Sweden; and Zurich in Switzerland.

The study split the delay into four categories:
  • How long it took before patients made a request to see a healthcare professional about their symptoms
  • The amount of time it took for the professional to see the patient
  • The subsequent time frame for the healthcare professional to make a referral to a rheumatologist
  • And lastly, the time span until the rheumatologist eventually saw the patient
The results of each component to the total time of delay varied between individual centers with patients in the UK waiting an average of 12 weeks before seeing their GP, compared to Heraklion where patients waited up to an average of 22 weeks before seeking help from a healthcare professional, whilst patients in Berlin and Vienna saw a healthcare professional within an average of only 2 weeks.

Significant variations between delays at the other three levels studied revealed, that the average amount of time it took for the professional to see the patient varied from 1 to 12 weeks, for healthcare professionals to make a referral to a rheumatologist the average time was 2 to 12 weeks; and for the rheumatologist to see the patient varied from an average of 1 to 11 weeks.

The authors point out, that a report from the UK's National Audit office calculates that doubling the current estimated 10-20% of patients treated with disease modifying drugs within three months of symptom onset might increase costs to the NHS by £11 million over 5 years, however, expectations of productivity gains for the UK alone could be around £31 million in addition to increasing quality of life for patients.

The researchers concluded:

"Across Europe, delays in the assessment of patients with rheumatoid arthritis [RA] by rheumatologists are unacceptably long. As highlighted in a recent report from the UK National Audit Office, tackling this should represent a priority for strategies to improve patient outcomes."

Written by Petra Rattue