Much of the movement towards EACs in the 1990s is credited to work by Dr. Emery early in that decade. He was a founder of the Early Rheumatoid Arthritis Study in 1986, and later the Leeds Early Arthritis Project and Yorkshire Early Arthritis Register. His goal has been the prevention of damage by changing the course of RA. He says the most difficult aspect of that early work was patient recruitment and uncertainty about whether patients would get better in the short term. Happily, their short-term improvement has carried into the long term as well.
The Leeds EAC defines “early” RA patients as those with symptom duration of less than one year, but “ideally three months,” Dr. Emery says. Patients are seen within two weeks of referral.
The Challenge: Getting Primary Care Referrals
Because there were initial difficulties in getting the cooperation of local general practitioners to refer early suspected cases of RA, the Leeds EAC team contacted local physicians to re-educate them to the importance of early treatment.
Dr. Emery, along with colleagues from The Netherlands, France, Germany, Austria, and the United States, authored a review article that discussed evidence-based development of a clinical guide for early referral recommendations.4 The article advises rapid referral to a rheumatologist if the patient has three or more swollen joints, metatarsophalangeal/metacar-pophalangeal involvement, and morning stiffness lasting 30 minutes or more.
The Austrian rheumatologist contributing to that review was Dr. Smolen, who, along with his associate, Klaus Machold, MD, associate professor in rheumatology at the University of Vienna, started Vienna’s Früharthritis-Ambulanzen EAC in 1996 to provide early treatment and to establish guidelines for fast decision making regarding DMARDs. “This meant we had to reduce the time lag from first telephone contact with the clinic to the actual appointment with the rheumatologists in our clinics,” says Dr. Smolen. “It also meant we needed to reduce the delay in which patients went to a physician because of their joint problems.”
To accomplish this, the doctors devised an information campaign for both physicians and the lay public. “We spoke to representatives of the social security organizations and the president of the chamber of physicians, who liked and supported our initiative,” he says. “We held press conferences for the mass media in order to reach the public. We wrote a series of educational articles on RA and the importance to recognize it early, and these were published in the journal of the chamber of physicians.”
