Open-access clinic for arthralgia: patient flow and diagnostic pathways-a retrospective cohort study

Despite the importance of early diagnosis in inflammatory arthritis (IA), particularly rheumatoid arthritis (RA), diagnostic time intervals often exceed months even in early arthritis recognition clinics (EARCs). This study aimed to describe patient flow through an open-access arthralgia clinic (OAC). In addition, to explore associations between referral pathways, diagnostic time intervals, and disease activity in RA patients.

In this Danish single-centre retrospective cohort study, patients referred from general practitioners to the OAC (2013-2018) underwent brief rheumatological assessments and were either discharged or referred to the EARC. Patients assessed in the OAC and later diagnosed with RA were compared with RA control patients referred directly to the EARC.

Of 761 patients seen at the OAC, 156 (20%) were referred directly to the EARC, while 605 (80%) were discharged; 50 (7%) of these were later re-referred to the EARC. At the EARC, 87 patients (11%) were diagnosed with IA, including 37 (5%) with RA, of whom 32 were referred directly from the OAC, and 5 were directly re-referred after initial OAC discharge. Compared with RA controls, the 32 RA patients initially assessed at the OAC had a shorter median time from symptom onset to diagnosis (92 vs 192 days, P < .05), with 47% diagnosed within 3 months. Disease activity at diagnosis was similar between OAC patients and RA controls, despite different disease durations.

In this observational study, the OAC was associated with shorter diagnostic time intervals for RA patients, supporting the potential of open-access triage in early assessment.