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Rheumatology visit frequency and changes in functional disability and pain in patients with rheumatoid arthritis
1Medical Service, Palo Alto Veterans Affairs Medical Center, CA 94304, USA.
Objective:
To determine if the frequency of visits to rheumatologists by patients with rheumatoid arthritis (RA) is associated with either short term (6 month) or longterm (10 year) changes in functional disability or pain.
Methods:
Information on health care utilization and health status was obtained for up to 10 years by biannual mailed Health Assessment Questionnaires (HAQ) in a community based cohort of patients with RA. We studied the relationship between the frequency of visits to rheumatologists and changes in functional disability and pain among 127 patients who were treated by a rheumatologist at least once each year.
Results:
The median visit frequency was 7.2 visits/year (range 2-17.5 visits/year). The number of rheumatology visits was significantly associated with short term changes in both functional disability and pain: each additional visit in a 6 month study interval was associated with a decrease in the pain score in the current interval by an average of 0.02 points (on a 3 point scale), and each additional visit was associated with a decrease in the HAQ Disability Index in the subsequent 6 month interval by an average of 0.007 points (on a 3 point scale). In analyses of longterm changes in health status, there was a U-shaped relationship between the frequency of rheumatology visits and the rate of progression of functional disability over time, with the lowest rates associated with average visit frequencies of between 7 and 11 visits/year. Average pain scores over time were positively correlated with the average annual frequency of rheumatology visits (r = 0.25).
Conclusion:
More frequent visits to rheumatologists were associated with greater improvements in pain and functional disability over periods of 6 and 12 months, respectively. Rates of progression of functional disability over time were also higher among patients with less than 7 visits/year than among those with 7-11 visits/year, suggesting that the outcomes of these patients might have been improved with more frequent visits.