Background/Purpose: Early treatment is regarded as critical for optimal clinical outcomes in patients with inflammatory rheumatic diseases. However, delayed diagnosis is recognized in many rheumatic diseases.  We studied possible delay in diagnosis in routine care in a rheumatology teaching hospital in 2013, using a simple 1-page form completed by the rheumatologist.

Methods: All patients seen in the study setting complete a multidimensional health assessment questionnaire (MDHAQ) at each visit in the waiting area before seeing  the rheumatologist. The rheumatologist completes a complementary doctor form (RHEUMDOC). RHEUMDOC includes entry of 3 possible rheumatic diagnoses, queried for year of onset of symptoms and year of diagnosis. For this study, patients were classified into 4 groups according to diagnosis: rheumatoid arthritis (RA), osteoarthritis (OA), other inflammatory diseases (INF), and other non-inflammatory diseases (NON); differences between groups were compared using Wilcoxon rank sum tests.

Results: Among 211 patients seen between February and December 2013, 145 (69%) reported establishment of a diagnosis within one year, including 81% with RA, 55% with OA, 70% with other INF, and 57% with other NON (Table). The delay in RA was significantly less than in OA (p=0.0046). Nonetheless, 10% of RA patients received a diagnosis 1-5 years, and 8% >5 years, after symptom onset.  Among all patients,  13% of RA patients received a diagnosis 1-5 years after onset of symptoms, and 18% after more than 5 years after onset of symptoms. 

Diagnosis	Number of patients	Number of patients in each group according to interval from onset of symptoms to diagnosis
		<1 year N (%)	1-5 years N (%)	>5 years N (%)
RA	59	48 (81%)	6 (10%)	5 (8%)
OA	45	25 (55%)	10 (22%)	10 (22%)
Other INF	86	60 (70%)	8 (9%)	18 (21%)
Other Non-INF	21	12 (57%)	4 (19%)	5 (24%)
Total	211	145 (69%)	28 (13%)	38 (18%)

Conclusion: A delay from onset of symptoms to definitive diagnosis remains an important problem in rheumatic diseases. Delay in diagnosis more than 1 year is more common in patients with diseases other than RA, but remains in more than 30% of all patients and 19% of RA patients. Identification of specific contributors to this delay could inform education of both patients and physicians regarding the importance of early diagnosis and treatment, and health policy resources to facilitate timely management of rheumatic diseases.

---

« Back to 2014 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/delay-in-diagnosis-from-onset-of-symptoms-by-more-than-one-year-in-31-of-patients-with-different-rheumatic-diseases-in-australia/