Early treatment with rheumatologist may decrease costly interventions in people with RA

Nov 7 2011

Early and appropriate treatment by a rheumatologist may decrease costly interventions —such as orthopedic surgery — in people with rheumatoid arthritis, according to research presented this week at the American College of Rheumatology Annual Scientific Meeting in Chicago.

Rheumatoid arthritis is a chronic disease that causes pain, stiffness, swelling, and limitation in the motion and function of multiple joints. Though joints are the principal body parts affected by RA, inflammation can develop in other organs as well. An estimated 1.3 million Americans have RA, and the disease typically affects women twice as often as men.

Optimal care for RA includes the use of disease-modifying antirheumatic drugs (commonly called DMARDs) to prevent joint damage and decrease the need for future surgery. When used in the treatment of rheumatic diseases, DMARDs are best administered and monitored by rheumatologists, and researchers recently set out to determine if seeing a rheumatologist early in the course RA would prevent people from needing orthopedic surgery.

Led by Debbie Feldman, PhD; full professor, Faculty of Medicine, School of Rehabilitation, Université de Montréal, the research team studied 3,890 people in Quebec with RA from 1995 to 2007. Participants were considered "early consulters" if they were seen by a rheumatologist within three months of being diagnosed with RA by a referring physician. Conversely, participants were considered "late consulters" if they were seen more than three months after the initial diagnosis, and were considered "undetermined consulters" if they were first diagnosed with RA by a rheumatologist.

The majority of participants were women with an average age of 56 years. Most were considered undetermined consulters (73 percent); 13.7 percent were early consulters and 13.3 percent were late consulters.

The researchers used billing codes (codes submitted by physician offices to insurers to report what was done during a patient visit used for medical services reimbursement) to track the progress of each study participant to determine if and when they needed orthopedic surgery during a 12-year time period. Among all the participants, 15.3 percent needed orthopedic surgery during the study.

Participants who consulted a rheumatologist within three months of being first diagnosed by another doctor were almost 40 percent less likely to have had orthopedic surgery compared to those who consulted with a rheumatologist after three months from first diagnosis.

"Using more complex statistical models to account for other factors that may be associated with having surgery —such as age and severity of the disease at diagnosis — we showed that those who consulted later than three months were almost twice as likely to undergo orthopedic surgery as compared with those who consulted a rheumatologist earlier," explains Dr. Feldman.

These findings add more support to other research that shows early treatment with a rheumatologist helps people with rheumatic diseases lead longer, healthier lives and alleviates the need for costly medical treatment. "In addition to improving patient outcomes, this research shows appropriate medical treatment under the supervision of a rheumatologist may also decrease costly interventions such as orthopedic surgery. Our results add more credence to support early treatment guided by a rheumatologist in patients with rheumatoid arthritis," says Dr. Feldman.

Source: American College of Rheumatology