OUTCOMES FOR PERSONS WITH RHEUMATOID-ARTHRITIS WITH A RHEUMATOLOGIST VERSUS A NON-RHEUMATOLOGIST AS THE MAIN PHYSICIAN FOR THIS CONDITION

OBJECTIVE. The authors compared outcomes among persons with rheumatoid arthritis (RA) with a rheumatologist versus a non-rheumatologist as t he main physician for this condition. METHODS. A cohort of 1,025 perso ns with rheumatoid arthritis were followed for as long as 11 years. Th e principal measures were obtained from an annual structured telephone interview conducted by a trained survey worker. All persons with rheu matoid arthritis originally were selected from a random sample of comm unity rheumatologists, but some subsequently had migrated to the pract ices of non-rheumatologists. The main outcome measures included the nu mber of painful and swollen joints, extent of morning stiffness, a glo bal pain rating, functional status, and a measure of global improvemen t. RESULTS. The persons with rheumatoid arthritis treated by rheumatol ogists reported significantly better functional status, fewer painful joints, and a lower overall pain rating, although the magnitude of the se differences was small. A significantly greater proportion of the pe rsons with rheumatoid arthritis-treated by rheumatologists also report ed improvement in a global measure of rheumatoid arthritis outcome and simultaneous improvement in all outcome measures. On all other outcom e measures, the point estimate favored those with a rheumatologist as the main rheumatoid arthritis physician, although the differences did not reach statistical significance. CONCLUSIONS. The evidence suggests an advantage for persons with a rheumatologist as the main rheumatoid arthritis physician, but on several of the measures of outcome, the m agnitude of the advantage was small. Because the present study was an observational design, the possibility that the advantage among persons with a rheumatologist as the main rheumatoid arthritis physician is a n artifact of selection bias cannot be ruled out.