Care pathways in early rheumatoid arthritis.

OBJECTIVE To determine the proportion of family physicians who diagnose rheumatoid arthritis (RA) correctly and to note how they report they would manage RA patients.

DESIGN Mailed survey (self-administered questionnaire) requesting comments on vignettes.

SETTING Province of Quebec.

PARTICIPANTS Computer-generated random sample of family physicians registered with the Quebec College of Family Physicians.

MAIN OUTCOME MEASURES The proportion of family physicians who recognized RA and their reported management strategies.

RESULTS Most respondents recognized the vignette presentation as a case of RA; 133/138 (96.4%) indicated RA as their provisional diagnosis, and all but 1 of the remaining respondents listed RA as a differential diagnosis. Of those who considered RA as a provisional or possible diagnosis, 107 (77.5% of all respondents) suggested referring the patient to a rheumatologist. Among the physicians who suggested referral, none indicated they would initiate disease-modifying antirheumatic drugs (DMARDs).

CONCLUSION Almost all respondents considered RA as a provisional or differential diagnosis. Although many suggested referring the patient to a rheumatologist, almost a quarter did not. Initiating DMARDs before referring patients to rheumatologists appears to be rare. Since DMARDs given during the early stages of RA are known to decrease damage and dysfunction, ways to increase their use and optimize care pathways for new-onset inflammatory arthritis are urgently needed.