RA Care Today: Key Quality Markers

Remission Medical clinicians pay very close attention to six (6) markers of care quality in RA (Rheumatoid Arthritis) that, per a recent study, could improve outcomes for patients.  A key quality marker is speed of referral, which bears completely on what’s called TTD or Time to Diagnosis.

The analysis of insurance claims data covering more than half a million RA patients found that fewer than half had been referred to a rheumatologist within 1 year of initial diagnosis, and other five (5) quality markers were met even less often.

The December 12, 2022 article published in JAMA Network Open titled “Factors Associated With Quality Care Among Adults With Rheumatoid Arthritis,” indicated that 31.3% of the patients met none of the six care quality markers examined in the study reported in JAMA Network.

The markers were derived from Arthritis Foundation recommendations and included:

  1. Rheumatologist referral
  2. Prescription of disease-modifying anti-rheumatic drugs (DMARDs) coupled with hepatitis B screening
  3. Hand x-rays in first year after diagnosis
  4. Annual physical exam
  5. Annual lab testing
  6. Referral for occupational or physical therapy or hand surgery.


The analysis covered some 581,000 individuals with RA diagnoses included in the IBM Truven MarketScan database from 2009 to 2017. Patients with non-RA forms of inflammatory arthritis were generally excluded, but those with comorbid osteoarthritis were not. People younger than 18 or older than 64 were also excluded. Mean age at the first record of RA diagnosis in the final sample was 49, and about 75% were women.

Care in about 68% of cases met at least one of these markers, but not one of them was met in as many as half. Rheumatologist referral, at 44.1%, occurred most commonly, followed by DMARD prescription with hepatitis B screening at 32.5%. The other four markers were met in fewer than 10% of cases. Referral for occupational or physical therapy almost never happened in the first year of treatment (0.3% and 0.7%, respectively).

The authors also looked at how the markers related to each other. Interestingly, an early rheumatologist referral correlated negatively with the likelihood of DMARD prescription (OR 0.24, 95% CI 0.24-0.25) and with subsequent referrals for hand surgery or physical/occupational therapy. It did, however, increase the odds of hand x-rays and lab testing.

Additionally, the group wrote, “Our study indicates that receiving DMARDs with or without hepatitis B screening is associated with greater odds of meeting later quality care markers, such as radiographs, annual laboratory testing, annual physical examination, and [physical/occupational therapy] or hand surgery referral.”

The authors indicated that DMARD prescription predicts patients’ overall treatment adherence, such that “long-term outcomes for patients with RA may be improved through direct disease activity and the downstream effects of meeting additional quality care markers.”