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Republished: A systematic literature review of strategies promoting early referral and reducing delays in the diagnosis and management of inflammatory arthritis
  1. Edith Villeneuve1,
  2. Jackie L Nam2,
  3. Mary J Bell3,
  4. Christopher M Deighton4,
  5. David T Felson5,
  6. Johanna M Hazes6,
  7. Iain B McInnes7,
  8. Alan J Silman8,
  9. Daniel H Solomon9,
  10. Andrew E Thompson10,
  11. Patience H P White11,
  12. Vivian P Bykerk12,
  13. Paul Emery13
  1. 1Department of Rheumatology, CHUM, Montreal, Canada
  2. 2Section of Musculoskeletal Disease and NIHR Leeds Institute of Molecular Medicine, University of Leeds, Leeds, UK
  3. 3Department of Rheumatology, Sunnybrook Health Sciences Centre, Toronto, Canada
  4. 4Department of Rheumatology, Royal Derby Hospital, Derby, UK
  5. 5Clinical Epidemiology Research and Training Unit, Boston University, School of Medicine, Boston, Massachusetts, USA
  6. 6Department of Rheumatology, ErasmusMC, Rotterdam, Netherlands
  7. 7Glasgow Biomedical Research Centre, University of Glasgow, Glasgow, UK
  8. 8Arthritis Research UK, Chesterfield, Manchester, UK
  9. 9Division of Rheumatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
  10. 10Department of Rheumatology, University of Western Ontario, London, Canada
  11. 11Division of Rheumatology, The George Washington University, Washington DC, Washington, USA
  12. 12Division of Rheumatology and Immunology, Brigham and Women's Hospital, Boston, Massachusetts, USA
  13. 13Section of Musculoskeletal Disease and and NIHR Leeds Musculoskeletal Biomedical Research Unit, University of Leeds, Leeds, UK
  1. Correspondence to Professor Paul Emery, University of Leeds, Section of Musculoskeletal Disease and NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK; p.emery{at}


Background Despite the importance of timely management of patients with inflammatory arthritis (IA), delays exist in its diagnosis and treatment.

Objective To perform a systematic literature review to identify strategies addressing these delays to inform an American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) taskforce.

Methods The authors searched literature published between January 1985 and November 2010, and ACR and EULAR abstracts between 2007–2010. Additional information was obtained through a grey literature search, a survey conducted through ACR and EULAR, and a hand search of the literature.

Results (1) From symptom onset to primary care, community case-finding strategies, including the use of a questionnaire and autoantibody testing, have been designed to identify patients with early IA. Several websites provided information on IA but were of varying quality and insufficient to aid early referral. (2) At a primary care level, education programmes and patient self-administered questionnaires identified patients with potential IA for referral to rheumatology. Many guidelines emphasised the need for early referral with one providing specific referral criteria. (3) Once referred, early arthritis clinics provided a point of early access for rheumatology assessment. Triage systems, including triage clinics, helped prioritise clinic appointments for patients with IA. Use of referral forms standardised information required, further optimising the triage process. Wait times for patients with acute IA were also reduced with development of rapid access systems.

Conclusions This review identified three main areas of delay to care for patients with IA and potential solutions for each. A co-ordinated effort will be required by the rheumatology and primary care community to address these effectively.

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  • This is a reprint of a paper that first appeared in Ann Rheum Dis, 2013, Volume 72, pages 13–33.

  • Funding The study was funded by the American College of Rhematology/European League Against Rheumatism.

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.