The analysis of performance measures for rheumatoid arthritis (RA) care have allowed to identify gaps in care that include suboptimal use of disease-modifying anti-rheumatic drugs (DMARDs), according to a study published in Arthritis Care & Research.

In this longitudinal, population-based cohort study of patients with RA, 4 performance measures were assessed: the percentage of patients with newly diagnosed RA with at least 1 visit to a rheumatologist within 1 year of diagnosis; the percentage of patients with prevalent RA who consulted a rheumatologist ≥ 1year; the percentage of patients with prevalent RA who were prescribed a DMARD; and the time from RA diagnosis to first DMARD prescription.

In this cohort, 38,673 patients had incident RA and 57,922 patients had prevalent RA. The percentage of patients consulting a rheumatologist within a 1-year period increased from 35% in 2000 to 65% in 2009. Among patients who ever saw a rheumatologist during follow-up or within the first 5 years of follow-up, performance increased (74% in 2000 to 96% in 2009 and 88% in 2000 to 97% in 2009, respectively)).

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The percentage of patients initiating rheumatologist care in 2000 or later who had yearly rheumatology follow-up visits declined during each following calendar year. Regardless of when patients entered care, the percentage of subsequent yearly follow-up visit declined from 79% in 2001 to 39% in 2014 using the fixed interval method, and from 82% in 2001 to 42% in 2014 using the gap method.

Overall DMARD use was found to be suboptimal among patients who were not under active rheumatologist care with little improvement observed over time. Among all of the patients with RA, only 37% received DMARD treatment in 2014, regardless of the specialty of the physician providing care. In patients who reported ever seeing a rheumatologist during follow-up, and in patients who were under rheumatologist care, the percentage of DMARD use increased to 57% in 2014.

Among those who received DMARD therapy, median time from RA diagnosis to DMARD initiation was 49 days in 2000 and 23 days in 2009, with a decline in the 90th percentile time noted, from 1644 days in 2000 to 118 days in 2009. Investigators reported an increase over time in the percentage of patients who received DMARD therapy within 14 days of RA diagnosis, from 21% in 2000 to 34% in 2009. A sensitivity analysis using a 30-day benchmark resulted in further increased rates: from 28% in 2000 to 43% in 2009.

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Study limitations include those inherent to the use of administrative data and of the possibility of incomplete or inaccurate data on patient registration.

“The results of this study will inform further reporting on the measures nationally and help serve in benchmarking when planning quality improvement and advocacy work,” the researchers concluded. “Timely communication of performance at the practice level could be used to influence clinical care, and at the provincial level, could inform health policy.”


Barber CEH, Marshall DA, Szefer E, et al. A population-based approach to reporting system-level performance measures for rheumatoid arthritis care [published online March 7, 2020]. Arthritis Care Res. doi: 10.1002/acr.24178