For patients with early rheumatoid arthritis (RA), structured treatment programs in early arthritis clinics are more effective in improving activity and preventing major radiographic progression than nonprotocolized referral and follow-up. A clinic should be able to provide easy access to expert consultation within 2 weeks of referral.
Descalzo and associates compared an RA cohort from reference hospitals in which a specific intervention was established and a historical control cohort of patients with early RA attending rheumatology departments. They tested treatment effectiveness by comparing changes in the Disease Activity Score in 28 joints (DAS 28), the Health Assessment Questionnaire (HAQ), and the Sharp/van der Heijde radiologic score.
Intervention was inversely correlated with disease activity, resulting in a decrease of −0.24 units in the population average of the DAS 28 after adjustment. The total Sharp/van der Heijde score at baseline, rheumatoid factor positivity, and time were associated with radiographic progression, but intervention may be seen as a protective factor of radiologic damage, especially for erosions. Although a decrease in functional impairment was detected, intervention was not statistically associated with HAQ decrements after adjustment.
The authors suggested that the study of RA in its early stages should be a research priority and management of RA in its early stages should be a priority in health care delivery.
