Background/Purpose:

Early introduction of disease-modifying anti-rheumatic drugs (DMARDs) has been shown to reduce joint destruction and long-term disability in rheumatoid arthritis (RA). Substantial and irreversible harm can occur as little as 12 weeks after onset of symptoms.  Recent international studies have examined time to institution of DMARD in early RA, with median delays of between 13 and 36 weeks. The aim of the present study was to examine the time to DMARD therapy in Australian patients with early RA.

Methods:

The study included patients referred to a metropolitan tertiary hospital and to 14 community-based rheumatologists in Australia. The hospital-based patients were identified retrospectively via hospital records and included patients with early RA who were first seen between January 2008 and October 2012. Medical charts were reviewed and, if necessary, the local doctor contacted for additional information. The community-based patients were recruited via the treating rheumatologists and data were collected prospectively by the rheumatologists over the period February 2012 to April 2013.  Data recorded included dates of symptom onset, initial local doctor consultation, referral to rheumatologist, rheumatologist review and commencement of DMARD. Serologic status and first DMARD commenced were also noted.

Results:

One hundred and thirty five patients (66% female, mean±SD age 55±16 years) were identified and contributed data. RhF and/or ACPA was positive in 66% (n=89) of patients. The median time from symptom onset to initiation of DMARD therapy was 163 days (inter-quartile range (IQR) 88-323). The median time from referral to first rheumatology appointment was 33 days (IQR 9-55) and from first rheumatology appointment to DMARD commencement was 0 days (range 0-22). The major component of the delay comprised the time from symptom onset to referral to the rheumatologist, for which the median duration was 98 days (range 51-239).  Stratified analysis did not reveal any substantial differences in delays between hospital-based and community-based patients. However, among hospital-based patients, ACPA positive status resulted in more rapid commencement of DMARD therapy (median 35 vs 93 days from time of referral, p=0.014). The first DMARD commenced was methotrexate monotherapy in 61% (n=82) of patients and methotrexate combination therapy in 5% (n=7) of patients.

Conclusion:

As noted in other countries, there are considerable delays in the commencement of DMARD therapy for Australian patients with early RA.  A substantial component of the delay is prior to the referral of the patient by the local doctor for rheumatologist review.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/time-to-institution-of-disease-modifying-anti-rheumatic-drugs-in-australian-patients-with-early-rheumatoid-arthritis/