Background/Purpose:

Delay in initiation of disease-modifying anti-rheumatic drug (DMARD) therapy may be a major contributing factor toward poor outcomes in patients with rheumatoid arthritis (RA). Many patients, however, undergo delay in diagnosis and treatment initiation in routine care regardless of rheumatologists’ awareness. In this study, we aim to evaluate improvement according to multidimensional health assessment questionnaire (MDHAQ) scores in DMARD-naïve RA patients with and without delay in initiation of treatment.

Methods:

We retrospectively reviewed all DMARD-naïve RA patients seen at a single academic site from 2011/16 who had an MDHAQ form at baseline visit and 6-month follow-up MDHAQ. Disease duration was derived from symptom onset to the time of first visit at our rheumatology clinic. We classified patients as “no delay” (<6 months) or “delay” (>6 months) to treatment according to the ACR definition ¹. Demographic, clinical data and the change from baseline to follow-up were compared in no delay versus delay groups using t-tests; %change from baseline in each group was also calculated. Mean change in MDHAQ scores in each group were compared with minimal clinically important improvement (MCII) ².

Results:

Seventy-four patients were included; 33 (45%) with no delay and 41 (55%) with delay. By definition, median symptom duration at the first visit was significantly higher for the delay group (23 vs 2.2 months). No significant differences were seen in age, gender, ethnicity, rheumatoid factor, anti-cyclic citrullinated peptide antibody, type of DMARD initiated, and glucocorticoid dosage for both groups. Median interval from baseline to follow-up was not significant in both groups (6 months). Routine assessment of patient index data (RAPID3) and component scores improved in both groups at follow-up, greater improvement was noted in no delay vs delay (RAPID3 % change: -39% vs – 29%, respectively. RA disease activity index (RADAI) self-reported joint counts of 48 joints also improved in both groups at follow-up with greater improvement in no delay vs delay (-46% vs -31%). Mean change in RAPID3, physical function and patient global assessment scores from baseline to follow-up in each group met the minimal clinically important improvement thresholds, but not pain (table).

Conclusion:

A clinically significant improvement was seen in all DMARD –naïve RA patients after treatment initiation, according to MDHAQ questionnaire. However, greater improvement was seen when treatment was initiated <6 months of symptom onset, emphasizing the importance of early referral and initiation of DMARD. Further studies confirming these results in other larger cohorts are needed. MDHAQ is useful in detecting meaningful clinical changes in early RA patients.

References:

1. Arthritis Care Res (Hoboken), 2016 Jan.
2. Ann Rheum Dis, 2015 Sep.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/early-versus-delayed-treatment-in-patients-with-rheumatoid-arthritis-ra-in-routine-care-at-a-single-us-academic-center-better-response-according-to-mdhaq-multidimensional-health-assessment-questio/