23, 24 The reason is clear: RA has no disease-specific diagnostic features 25 and patients can present with a wide range of manifestations. 22 Moreover, in most referral letters from general practitioners, a tentative rheumatological diagnosis is either not stated or stated wrongly. 21 Other studies suggest that the long lag between symptom onset and the diagnosis of RA is mainly due to late referral rather than patient delay in reporting symptoms or long waits for outpatient appointments.
However, a recent audit in our unit showed that such patients were referred after a mean of 16 weeks (interquartile range 6-34) from onset of symptoms. 13 – 19 It was for these reasons that a SIGN (Scottish Intercollegiate Guideline Network) guideline 20 in 2000 indicated that a patient with inflammatory arthritis lasting >6–8 weeks should be referred for a specialist (rheumatology) opinion. Patients in whom DMARD therapy is introduced early have better function and radiological outcome in the long-term than those in whom it is delayed.
1 – 3 When joint damage was seen to be an early feature of the disease, 4 – 12 rheumatologists put forward the point at which they prescribed disease-modifying antirheumatic drugs (DMARD), in the hope of slowing or even arresting disease progression. It leads to irreversible joint damage and systemic complications, and the age-adjusted mortality of those affected exceeds that of the general population. Rheumatoid arthritis (RA) is a chronic systemic inflammatory disease that affects about 1% of the population.