Impact of a rapid access strategy on referral rates, diagnosis, and glucocorticoid initiation in suspected polymyalgia rheumatica

Abstract

Objectives

Diagnosing polymyalgia rheumatica (PMR) is difficult, and 50 % have initiated glucocorticoids (GC) before rheumatological evaluation, challenging the distinction from other conditions. Rapid access strategy (RAS) clinics for individuals with suspected PMR may reduce GC initiation before rheumatological evaluation, but evidence is limited. This study evaluates the impact of a RAS clinic compared with a traditional referral approach for individuals with suspected PMR.

Methods

This single-centre retrospective cohort study compared individuals suspected of PMR referred to a RAS clinic with a historical cohort. Comparisons included referral rates, time from referral to evaluation, diagnosis, and GC initiation before evaluation.

Results

Referral rates almost doubled after the RAS clinic was implemented with modest change in the proportion diagnosed with PMR at evaluation (70 % [95 % CI: 62–77] vs. 59 % [95 % CI: 52–65]). Compared with the historical cohort, more individuals in the RAS cohort were evaluated within one week (55 % [95 % CI: 49–62] vs. 36 % [95 % CI: 28–44]) and two weeks (89 % [95 % CI: 84–92] vs. 75 % [95 % CI: 67–81]). Additionally, fewer individuals initiated GCs before evaluation (9 % [95 % CI: 6–13] vs. 20 % [95 % CI: 15–28]) and fewer patients received GCs one year after diagnosis (50 % [95 % CI: 39–61] vs. 77 % [95 % CI: 62–89]). The proportion with subclinical giant cell arteritis remained low.

Conclusion

Implementation of a RAS clinic for individuals with suspected PMR increased referral rates, while modestly reducing the proportion diagnosed with PMR, and lowered the proportion of individuals initiating GCs before evaluation.