Direct transition to a streamlined rheumatoid arthritis clinic improves outcomes after discharge from an early arthritis clinic environment.

BACKGROUND: The treat-to-target (T2T) strategy for the management of rheumatoid arthritis (RA) achieves remission or low disease activity in many patients. However, RA T2T is challenging in real-world clinical environments. In this two-stage audit, we evaluated the impact of transferring patients from a T2T intensive early arthritis clinic (EAC) to a general rheumatology (GR) clinic, then assessed outcomes of a clinical redesign to facilitate direct transfer from EAC to a dedicated RA clinic. METHODS: We retrospectively audited 216 patients attending an EAC in Brisbane, Australia, who were discharged to a GR clinic (cohort 1, 2004-2015) and 122 patients who were discharged directly to a dedicated, streamlined RA clinic (cohort 2, 2019-2023). EAC discharge occurred when patients reached low disease activity or remission. RESULTS: Median 28-joint disease activity scores (DAS28) of 2.91, 95% confidence interval (2.38-3.26) (cohort 1) and 2.80 (2.37-3.28) (cohort 2) were achieved within 12 months in EAC. In cohort 1 patients returning to the GR clinic, median C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) rose and disease-modifying anti-rheumatic drug (DMARD) doses decreased significantly. In contrast, cohort 2 transited without delay to the RA clinic, and there were no changes in CRP, ESR or DMARD doses. CONCLUSIONS: Compared to GR, establishing a streamlined RA clinic with a model of direct transfer of care reduced delayed follow-up and improved medication adherence and maintenance of low disease activity after transition from EAC.