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Background: Early diagnosis and treatment of rheumatoid arthritis (RA) are essential to reduce disease progression and prevent long-term disability. The “treat to target” approach, as outlined in the National Institute for Health and Care Excellence (NICE) RA Quality Standards (QS), emphasizes early and effective treatment strategies tailored to individual patients. Despite the availability of evidence-based treatments, disparities in RA care remain prevalent, particularly in terms of timely referrals, diagnosis, and treatment initiation. A range of factors such as socioeconomic status, healthcare access, and ethnicity contribute to this variation. Recent data from the British National Early Inflammatory Arthritis Audit (NEIAA) has raised concerns about the ethnic variations in the timely management of inflammatory arthritis, specifically in relation to the NICE Rheumatoid Arthritis Quality Standard 33, which focuses on the prompt referral and treatment of RA.
Objectives: This comparative, retrospective, observational study aims to assess ethnic variations in the quality of care for patients with RA, as measured by adherence to NICE RA Quality Standard 33. Specifically, it compares the performance of Queen Elizabeth Hospital, Birmingham (QEHB) rheumatology service with national trends, focusing on two key metrics:
Quality Statement (QS) 1: Referral to rheumatology within 3 working days of primary care presentation.
Quality Statement (QS) 2: Initiation of conventional DMARDs within 6 weeks of referral.
Methods: This study involved a comparative evaluation of two datasets: one from QEHB rheumatology service and one from the NEIAA. The QEHB dataset comprised 262 patients who were enrolled in the hospital’s rheumatology service between April 2018 and March 2024. In contrast, the NEIAA dataset included data from 35,807 patients across the UK, who accessed specialist rheumatology services for the first time between May 2018 and March 2020. Patient ethnicity was categorized following the standard National Health Service (NHS) classification as White, Black British/African/Caribbean, Asian/Asian British, Mixed, and Other ethnic groups. For analytical purposes, these were further consolidated into binary categories: Black, Asian, and Minority Ethnic groups and White, to facilitate comparative analysis between the groups. Ethnic groups were assessed and compared based on the following metrics: Quality Statement (QS) 1, which evaluates referral to rheumatology within 3 days of primary care presentation, and QS 2, which measures the initiation of DMARDs within 6 weeks of referral.
Results: 262 patients were enrolled in the QEHB rheumatology service, compared to 35,807 patients across rheumatology services in the UK. Patients were categorized into two ethnic groups: Black, Asian, and minority ethnic groups (24%) at QEHB and 14% nationally, while the White group comprised 76% at QEHB and 86% nationally. Overall, 57.8% (115/146) of the White group were referred to the QEHB rheumatology service within 3 working days of presentation (QS33, Quality Statement 1), compared to 49.2% (31/146) of the Black, Asian, and minority ethnic group. In contrast, 43% (12,561/29,417) of White patients were referred to rheumatology services within three working days nationally, while 47% (2,333/4,964) of Black, Asian, and ethnic minority patients received referrals within this time frame. Therefore, a higher proportion of white patients are referred to QEBH within three working days, compared to national data, which shows that a larger proportion of Black, Asian, and ethnic minority patients are referred within the same time frame across the country. At QEHB, a higher proportion of Black, Asian, and minority ethnic group 56.3% (27/102) received treatment within 3 weeks, compared to 51.7% (75/102) of the White group. A similar pattern was observed nationally, where 60% (723/1,204) of Black, Asian, and ethnic minority patients received timely treatment, compared to 57% (4,919/8,695) of White patients, according to QS33, Quality Statement 2.
Conclusion: Comparing QEHB data with national data highlights ethnic healthcare disparities, especially given Birmingham’s diverse population. While the data reveals that a higher proportion of white patients at QEHB are referred within three working days, national data shows that a larger proportion of Black, Asian, and ethnic minority patients are referred within the same timeframe. However, a similar trend is observed in the initiation of treatment within three weeks, with both QEHB and national data indicating that a higher proportion of Black, Asian, and ethnic minority patients receive timely treatment compared to white patients. Due to the relatively small sample size at QEHB, these results should be interpreted with caution, as they may have limited generalisability. Further investigation is recommended to explore the reasons behind the low audit enrolment among patients from ethnic minority groups. Furthermore, the different time periods for data collection also introduce an important consideration. The national data was collected between May 2018 and March 2020, while QEHB data spans a longer period from April 2018 to March 2024. This difference could impact the interpretation of the results, as changes in healthcare policies, practices, or external events like the COVID-19 pandemic could have influenced referral and treatment patterns during these timeframes. In conclusion, these findings offer valuable insights into ethnic variations in RA care, but further research is needed to explore the underlying causes of these disparities. Addressing these factors is essential to ensuring fair and equitable care for all ethnic groups.
REFERENCES: NIL.
Acknowledgements: NIL.
Disclosure of Interests: None declared.
© The Authors 2025. This abstract is an open access article published in Annals of Rheumatic Diseases under the CC BY-NC-ND license (