Inflammatory Arthritis – The Importance of Early Diagnosis

This blog is written by our clinicians and aims to keep patients informed with up to date information on medical conditions. The editor of the blog is Dr Cristina Romete.

Inflammatory arthritis (such as Rheumatoid Arthritis, Psoriatic Arthritis, Anklyosing Spondylitis and more) encapsulates a group of joint disorders where inflammation and damage occurs to our joints as a result of a problem in our immune system where our immunity attacks and targets our joints. The inflammation causes the symptoms of pain, swelling, stiffness and loss of function in our joints.

Early Inflammatory Arthritis – identify and treat early to prevent disability, reduce pain and induce remission

The management of inflammatory arthritis has evolved considerably from what it was 20 years ago. Current research provides clear and copious evidence of the benefits of identifying and treating inflammatory arthritis early1-3. Disability is preventable through seeing patients early to identify promptly and treating intensively and proactively4-5.

How common is Inflammatory Arthritis and what are the effects?

Inflammatory arthritis affects over 1,000,000 people in England, (NAO 2009; RCP 2011). Many patients are young and of working age. There is often a rapid onset of severe symptoms. If treated late it leads to irreversible joint damage, disability and is associated with poor general health and higher risk of mortality compared to the general population6-7. Within a short time period, the disease can affect a person’s ability to undertake day to day activities including work and independent living.

What are the early symptoms?

Early symptoms linked to inflammatory arthritis usually include:

  • – Joint pain
  • – Morning joint stiffness
  • – Tenderness in and around the joint
  • – A reduced range of motion in 1 or more joints
  • – Redness and warmth around the affected joint

The recognition of early features of rheumatoid arthritis is extremely important for health-care professionals. By identifying inflammatory arthritis at the early stages of disease, joint inflammation can be addressed before damage occurs thereby preventing long-term consequences of the disease. Furthermore, because rheumatoid disease can affect other organs, early management can help maintain the health status throughout the body.

What are the barriers to early identification and treatment?

Studies have shown that the UK lags behind much of Western Europe in the management of early arthritis. Barriers to early diagnosis and treatment include people holding off seeing their doctor, delays in referral and accessing rheumatology services, and time taken to complete specialist diagnostic investigations.

Key message:

Time is of the essence in early arthritis because delays in treatment can result in a more aggressive course of disease leading to long-term joint damage and disability. 

What does the ROC offer?

A timely and comprehensive assessment of individuals with a history of early signs and symptoms of inflammatory arthritis and an opportunity to explore the full gamut of treatment options available if an inflammatory arthritis is confirmed. I am a specialist in the management of early arthritis and I have led in the development of regional services in early arthritis care.

 

  1. Wiles NJ, Lunt M, Barrett EM, et al. Reduced disability at 5 years with early treatment of inflammatory polyarthritis: results from a large observational cohort, using propensity models to adjust for disease severity. Arthritis Rheum 2001;44: 1033-42
  2. Stenger AA, van Leeuwen MA, Houtman PM, et al. Early effective suppression of inflammation in rheumatoid arthritis reduces radiographic progression. Br J Rheumatol 1998;37: 1157-63
  3. Tsakonas E, Fitzgerald AA, Fitzcharles MA, t al. Consequences of delayed therapy with second-line therapy in rheumatoid arthritis: a 3-year follow up on hydroxychloroquine in early rheumatoid arthritis (HERA) study. J Rheumatol 2000;27: 623-9
  4. Bukhari MAS, Wiles NJ, Lunt BJ, Scott DGI, Symmons DPM, Silman AJ. Influence of disease modifying therapy on radiographic progression in inflammatory polyarthritis at five years. Arthritis Rheum 2003;48: 46-53
  5. Anderson JJ, Wells G, Verhoeven AC, Felson DT. Factors predicting response to treatment in rheumatoid arthritis: the importance of disease duration. Arthritish Rheum 2000;43: 22-9
  6. Gabriel SE, Crowson CS, O’Fallon WM. Mortality in rheumatoid arthritis: have we made an impact in 4 decades? J Rheumatol 1999;26: 2529-33
  7. Young A, Dixey J, Cox N, et al. How does functional disability in early rheumatoid arthritis (RA) affect patients and their lives? Results of 5 years of follow-up in 732 patients from the Early RA study (ERAS). Rheumatology 2000;39: 603-1

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