Background/Purpose: although the Early Arthritis Clinic (EAC) institution is considered the best approach for the management of rheumatoid arthritis (RA) at an early stage, to the best of our knowledge there is no formal demostration that this organisational model is better than a conventional model  in terms of public health care and of improved clinical, therapeutic and radiographic outcomes. Our purpose was to evaluate whether significant differences in clinical and therapeutic outcomes exist between two groups of patients with Rheumatoid Arthritis followed in a EAC and in a routin care (RC) model, respectively.

Methods: Two groups of RA patients fulfilling 1987/ACR criteria were retrospectively analised.  In the first group, RA diagnosis was made in our centre between 2002 and 2008 and patients were followed with a RC model. In the second one, RA diagnosis was made in our centre between 2009 and 2013 and patients were followed in our EAC. Patients with a follow-up of at least 2 years were included. For each patient of the two groups, lag time from symptom onset to diagnosis and from symptom onset to the beginning of DMARDs therapy were calculated. Disease activity were compared between the two groups using DAS28 and EULAR response criteria at baseline (T0) and after 6 (T6), 12 (T12) and 24 (T24) months. The ratios (%) of patients who started a biological therapy within 24 years after diagnosis were compared between the two groups

Results:

A total of 273 RA patients, divided into two groups, were evaluated: 209 (mean age 59 ± 24.04 years,165 F, 44 M) followed in RC and 64 (mean age 59 ± 13.44 years, 50 F,14 M) in EAC. Lag time from symptom onset to diagnosis resulted significally lower (p<0,0001) in patients assessed in EAC (5.73 ± 8.09 mesi) compared to that of the other group (20.90 ± 30.3 mesi) and treatment beginning occured before in EAC population  (7.17± 8.26 mesi) respect to that followed in RC (21.98±32.39 mesi) with a significant difference (p<0.0004). At baseline DAS28 evaluation was similar between groups (4.76±1.24 in RC  vs 4.94 ± 1.41 in EAC ) and was significally reduced to 2.82 ± 1.24 (RC) and 2.46 ±1.12 (EAC)  after 24 months (p<0.036). A significant statistical difference emerged from the comparison to the mean VES value (19.9 ±15.9 RC vs 13.6 ± 11.3 EAC, p<0.003) and SJ (swollwn joints) value (1 ± 1.8 RC vs 0.43 ± 1.2 EAC, p<0.02) at T-24. Within 24 months, biologic therapy was initiated in 29% of patients followed in RC and in 9.3% of patients followed  in EAC population (p<0,0013).

Conclusion: In comparison with the RC model, the EAC institution has allowed in our experience a significant reduction of the time for diagnosis and for the therapeutic intervention, with an improvement in clinical outcomes, less use of biological drugs and a significant long-term savings on pharmaceutical spending

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/comparison-to-organisational-models-for-early-rheumatoid-arthritis-management-routine-care-versus-early-arthritis-clinic/