EARLY REFERRAL AND OUTCOME IN RHEUMATOID-ARTHRITIS

In a cross-sectional study of 200 outpatients with rheumatoid arthriti s (RA) we tested the hypothesis that early specialist referral within one year of disease onset reduces subsequent functional disability. Ea rly referral was defined as being seen in a specialist unit within one year of the onset of symptoms. Functional outcome was measured using the physical functional section of the full test (NHP) and (HAQ). Addi tional information was collected on other factors likely to influence disability including age, sex, pain scores, and rheumatoid factor posi tivity. The difference in average HAQ and NHP physical function scores between late and early referrals was 0.34 and 11.0 respectively (p<0. 01 in both cases) using unequal-variance t-test. After adjusting for t he other risk factors, multiple regression analysis showed late referr al patients had greater NHP physical function scores than early-referr ed patients by approximately 8 points and there was a similar trend wi th HAQ. We conclude that early referral for specialist advice is assoc iated with improved health status, with reduced physical function scor es on the NHP.