Rheumatoid arthritis referrals and rheumatologist scarcity: a prioritization tool

To assess whether applying the 2010 American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) criteria for rheumatoid arthritis (RA) to primary care referrals improved triage decisions and reduced waiting times, and to determine the sensitivity and specificity of this strategy.

The 2010 ACR/EULAR criteria for RA were prospectively applied over 8 months to all new adult rheumatology referrals with possible inflammatory arthritis. If the referral contained insufficient information, a request was sent for more information. Joint count was based on physician report, and definite swelling was not required. Referrals meeting triage criteria were offered an appointment within 6 weeks. Data were collected on rheumatologist diagnosis, disease-modifying antirheumatic drug (DMARD) use, and waiting times.

Of 457 referrals screened, 180 met inclusion and exclusion criteria, and 143 had sufficient data after requests for information. Seventy-one referrals met triage criteria, and of the 63 attending the appointment, 25 (40%) received a rheumatologist diagnosis of RA. Seventy-two referrals did not meet criteria, and 1 of 49 attending (2%) had RA. The characteristics of the tool for a diagnosis of RA were sensitivity 96%, specificity 56%, positive predictive value 40%, and negative predictive value 98%. Median wait times for referrals fulfilling and not fulfilling triage tool criteria were 7.9 weeks and 45.4 weeks, respectively.

Implementing the 2010 ACR/EULAR criteria for RA as a prioritization tool for primary care referrals improved the number of patients subsequently diagnosed with RA. Waiting time was reduced for RA patients. Applying this strategy in areas of rheumatologist scarcity may permit earlier DMARD treatment.