Arthritis & Rheumatism, Volume 63,
November 2011 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Chicago, Illinois November 4-9, 2011.

Early Consultation with a Rheumatologist for Rheumatoid Arthritis: Does It Reduce Subsequent Use of Orthopaedic Surgery?

Feldman1,  Debbie Ehrmann, Bernatsky2,  Sasha, Houde3,  Michelle, Beauchamp2,  Marie-Eve, Abrahamowicz2,  Michal

Université de Montréal, Montréal, QC
McGill UHC/RVH, Montreal, QC
Public Health Department of Montreal, Montreal, QC


Optimal care in rheumatoid arthritis (RA) includes early use of disease-modifying anti-rheumatic drugs to prevent joint damage and hopefully decrease surgical interventions. Our objective was to determine if persons with RA who saw a rheumatologist early in the disease course had a reduced rate of orthopaedic surgery.


All persons with a diagnosis of RA confirmed by a rheumatologist and based on billing code data in the province of Quebec, in 1995 were followed until 2007. Patients were classified as "early consulters" if they were seen by a rheumatologist within 3 months of being diagnosed with RA by their referring physician, "late consulters" if they were seen by more than 3 months after the initial RA diagnosis, and "undetermined" if they were first diagnosed with RA by a rheumatologist. Time to orthopaedic surgery, defined using ICD9 and ICD10 procedure codes, was compared with Cox's proportional hazards regression.


There were 3,890 patients with a confirmed RA diagnosis: mean age at diagnosis was 56.3 years and 69.4% were female. Most (73%) were "undetermined consulters"; 13.7% were "early" consulters and 13.3%"late" consulters. Among all patients, 15.3% (610) had an orthopaedic surgery during the observation interval. Patients in the early consultation group were less likely to undergo orthopaedic surgery over the 12 year follow-up period than those in the late consultation group (adjusted hazard ratio: 0.63; 95% confidence interval: 0.46, 0.85).


Persons diagnosed with RA who consult a rheumatologist later in the disease course have a worse outcome in terms of eventual orthopaedic surgery. In addition to improving patient outcomes, appropriate medical treatment under the supervision of a rheumatologist may also decrease costly interventions such as orthopaedic surgery. Our results add more credence to support early treatment guided by a rheumatologist in patients with rheumatoid arthritis.

To cite this abstract, please use the following information:
Feldman, Debbie Ehrmann, Bernatsky, Sasha, Houde, Michelle, Beauchamp, Marie-Eve, Abrahamowicz, Michal; Early Consultation with a Rheumatologist for Rheumatoid Arthritis: Does It Reduce Subsequent Use of Orthopaedic Surgery? [abstract]. Arthritis Rheum 2011;63 Suppl 10 :1546

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