Direct transition to a streamlined rheumatoid arthritis clinic improves outcomes after discharge from an early arthritis clinic environment
Hyunjun Jonathan Kim, Mitsi Blazos, Kevin Yen Chia Su, Ranjeny Thomas, Helen BenhamAbstract
Background
The treat‐to‐target (T2T) strategy for the management of rheumatoid arthritis (RA) achieves remission or low disease activity in many patients. However, RA T2T is challenging in real‐world clinical environments. In this two‐stage audit, we evaluated the impact of transferring patients from a T2T intensive early arthritis clinic (EAC) to a general rheumatology (GR) clinic, then assessed outcomes of a clinical redesign to facilitate direct transfer from EAC to a dedicated RA clinic.
Methods
We retrospectively audited 216 patients attending an EAC in Brisbane, Australia, who were discharged to a GR clinic (cohort 1, 2004–2015) and 122 patients who were discharged directly to a dedicated, streamlined RA clinic (cohort 2, 2019–2023). EAC discharge occurred when patients reached low disease activity or remission.
Results
Median 28‐joint disease activity scores (DAS28) of 2.91, 95% confidence interval (2.38–3.26) (cohort 1) and 2.80 (2.37–3.28) (cohort 2) were achieved within 12 months in EAC. In cohort 1 patients returning to the GR clinic, median C‐reactive protein (CRP) and erythrocyte sedimentation rate (ESR) rose and disease‐modifying anti‐rheumatic drug (DMARD) doses decreased significantly. In contrast, cohort 2 transited without delay to the RA clinic, and there were no changes in CRP, ESR or DMARD doses.
Conclusions
Compared to GR, establishing a streamlined RA clinic with a model of direct transfer of care reduced delayed follow‐up and improved medication adherence and maintenance of low disease activity after transition from EAC.