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The Early arthritis clinic Dr Fahim Khan. MD,MRCP,FRCP,FACP . Consultant Rheumatologist Aut Even Hospital Kilkenny . Early RA hands. Aims and ambitions . 1. Rapid and easy access (< 2 weeks) 2. Patient education 3. A comprehensive assessment to make an optimal diagnosis
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Emery and Gough2 pointed out that RA is the most common cause of potentially treatable disability in Western countries, based on recognition of longterm severity of clinical RA. At that time, general practitioners were advised to give patients a nonsteroidalantiinflammatory drug for up to 2 years before the use of disease modifying antirheumatic drugs (DMARD)3.
2.Emery P, Gough A. Why early arthritis clinics? Br J Rheumatol 1991;30:241–2.
3.Lightfoot RW, Jr. Treatment of rheumatoid arthritis. In: McCarty DJ, editor. Arthritis and allied conditions. 10th ed. Philadelphia: Lea & Febiger; 1985:668–76
Research concerning early arthritis and early rheumatoid arthritis (RA) may be thought to have begun in population-based studies in the late 1950s to late 1960s. These studies indicated that the majority of people who had clinical findings of RA had no evidence of disease 3–5 years later., and that only about 25%–30% of people in a population who met criteria for RA had rheumatoid factor4.
4.Sokka T, Pincus T.A historical perspective concerning population-based and clinical studies of early arthritis and early rheumatoid arthritis. Clin Exp Rheumatol 2003;21:S5–S14.
Observations from randomized clinical trials (RCT) support early versus delayed drug treatment in RA. The benefits of early versus delayed treatment have been documented in studies of intramuscular gold, auranofin, sulfasalazine, and hydroxychloroquine (as reviewed5).
5.Sokka T, Makinen H. Drug management of early rheumatoid arthritis — 2008. Best Pract Res ClinRheumatol 2009;23:93–102
IMPROVED LONGTERM OUTCOMES OF RA REFLECT EARLY AND ACTIVE TREATMENT STRATEGIES
Data from clinical cohorts and observational studies indicate that status and outcomes of RA patients have improved over the past decades concomitantly with implementation of early and active treatment strategies6-7.
6.Pincus T, Sokka T, Kautiainen H. Patients seen for standard rheumatoid arthritis care have significantly better articular, radiographic, laboratory, and functional status in 2000 than in 1985. Arthritis Rheum 2005;52:1009–19.
7.Sokka T, Kautiainen H, Mottonen T, Hannonen P. Erosions develop rarely in joints without clinically detectable inflammation in patients with early rheumatoid arthritis. J Rheumatol 2003;30:2580–4.
Symptomatic relief only
Some retardation of joint damage AND alleviation ofdisease signs and symptoms
AND ANY ONE OF THE FOLLOWING:
assessment in E.A.C.
2, Early diagnosis of Rheumatoid Arthritis.
3,Decision taken to initiate earlier use of DMARD therapy to prevent long term joint damage.
EAC Framework (New Referrals)
General Practitioner, Other Speciality
referred to rheumatology clinics.
DR FAHIM KHAN