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Abstract Number: 2132

Disease Activity and Anti-CCP Status, but Not Sociodemographic Factors or Patient Comorbidities, Affect Time to Diagnosis in Early Rheumatoid Arthritis

Cheryl Barnabe1, Juan Xiong2, Gilles Boire3, Carol A. Hitchon4, Boulos Haraoui5, Janet E. Pope6, J. Carter Thorne7, Edward Keystone8, Diane Tin9, Vivian P. Bykerk10 and Canadian ArThritis CoHort11, 1Medicine, Community Health Sciences, University of Calgary, Calgary, AB, Canada, 2University of Toronto, Toronto, Canada, 3Rheumatology Division, Centre Hospitalier Universitaire de Sherbrooke, Université de Sherbrooke, Sherbrooke, QC, Canada, 4University of Manitoba, Winnipeg, MB, Canada, 5Osteoarthritis Research Unit, University of Montreal Hospital Research Centre (CRCHUM), Montreal, QC, Canada, 6Medicine/Rheumatology, St. Joseph Health Care London, University of Western Ontario, London, ON, Canada, 7Southlake Regional Health Centre, Newmarket, ON, Canada, 8University of Toronto, Toronto, ON, Canada, 9The Arthritis Program, Southlake Regional Health Centre, Newmarket, ON, Canada, 10Rheumatology, Hospital for Special Surgery, New York, NY, 11Toronto

Meeting: 2012 ACR/ARHP Annual Meeting

Keywords: Diagnosis and rheumatoid arthritis (RA)

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Session Information

Title: Rheumatoid Arthritis - Clinical Aspects III: Infections/Risk Factors for Incident Rheumatoid Arthritis/Metrology/Classification/Biomarkers/Predictors of Rheumatolid Arthritis Activity & Severity

Session Type: Abstract Submissions (ACR)

Background/Purpose: Delays in patient presentation to primary care providers,  subsequent referral for rheumatology assessment, and recognition of rheumatoid arthritis (RA) by the rheumatologist increase time to diagnosis. This time period is a modifiable determinant of joint damage and affects the odds of entering remission, and factors impacting this time must be elicited. Our aim was to evaluate whether time to diagnosis is influenced by measures of disease severity or a family history of RA, sociodemographic factors affecting access to care (age, sex, socioeconomic status [SES], education level, ethnicity), or comorbidities that may influence the physical examination, such as obesity, mental health conditions, or other musculoskeletal pain conditions.

Methods: A prospective national cohort of patients with confirmed or possible RA by 2010 ACR criteria (n=1,151) was evaluated for predictors of the duration of time to diagnosis. Variables examined in univariate analysis are summarized in Table 1. Simple linear regression was applied to each variable, and significant predictors carried forward to multivariate linear regression.

Results:

TABLE 1. Variables Assessed in Univariate Analysis for Time to Diagnosis

Female

74%

Age, mean (SD)

54 (14.7) years

Caucasian ethnicity

83%

BMI, mean (SD)

28.6 (10.5)

DAS28, mean (SD)

5.02 (1.44)

Swollen joint count, mean (SD)

28 Joints: 7.7 (6.0); 66 Joints: 9.8 (7.9)

Tender joint count, mean (SD)

28 Joints: 8.3 (6.5); 66 Joints: 12.7 (9.4)

HAQ, mean (SD)

1.02 (0.70)

Patient Global (VAS 0-10), mean (SD)

5.7 (2.9)

Acute Phase Reactants, mean (SD)

ESR: 28.1 (22.6) mm/hr; CRP: 14.4 (17.8) mg/L

Serology

Rheumatoid factor positive 67%; Anti-CCP positive 58%

Education

Only elementary or high school 46%; College or post-secondary 51%

Annual Income

<$20,000: 12%; $20,000-$50,000: 24%; $50,000-$100,000: 18%; >$100,000: 8%

Mental Health Condition

Depression: 11%; Other: 1%

Fibromyalgia

2%

Osteoarthritis

11%

Family History of RA

22%

The mean symptom duration at the baseline rheumatology visit was 6.0 months (range 0.1-19.6). In univariate analysis, age, joint counts, DAS28, patient global, HAQ, ESR, CRP, education level and anti-CCP status were all significant predictors (p<0.05) for time to diagnosis, whereas BMI, sex, ethnicity, income, RF status, family history of RA, and history of depression, fibromyalgia or osteoarthritis had no effect. In multivariate analysis, higher swollen joint counts, higher ESR, worse patient global scores, and negative anti-CCP antibody status were significant predictors of shorter time to diagnosis (Table 2).

TABLE 2. Multivariate Analysis for Predictors of Time to Diagnosis

Parameter

Estimate

95% CI

P-value

Intercept

7.789

7.257; 8.322

<.0001

Swollen Joints

-0.051

-0.089; -0.013

0.0085

ESR

-0.016

-0.026; -0.006

0.0017

Patient Global Score

-0.085

-0.161; -0.009

0.0280

Damaged joint count

-0.090

-0.204; 0.023

0.1192

Anti-CCP Positive

0.814

0.383; 1.245

0.0002

Conclusion: Recognition of RA is not affected by a family history, sociodemographic factors, body habitus, mental health conditions, or other musculoskeletal pain syndromes. Worse patient global, more swollen joints, higher ESR and anti-CCP status influence time to diagnosis. The impact of fewer swollen joints and normal laboratory parameters on delay to diagnosis merits further consideration.



Disclosure:

C. Barnabe,

UCB, Pfizer, Amgen, Roche, Janssen BMS, ,

5;

J. Xiong,
None;

G. Boire,
None;

C. A. Hitchon,
None;

B. Haraoui,
None;

J. E. Pope,
None;

J. C. Thorne,
None;

E. Keystone,

Abbott Laboratories Amgen Inc, AstraZeneca Pharamceuticals LP, Bristol-Myers Squibb, Centocor Inc, F. Hoffmann-LaRoche Inc, Genzyme, Merck, Novartis Pharmaceuticals, Pfizer Pharmaceuticals, UCB,

2,

Abbott Laboratories, AstraZeneca Pharma, Biotest, Bristol-Myers Squibb, Centocor Inc, F. Hoffman-LaRoche Inc, Genentech Inc, Merck, Nycomed, Pfizer Pharmaceuticals, UCB, Amgen, Janssen Inc,

5;

D. Tin,
None;

V. P. Bykerk,

Amgen, Pfizer, Roche, BMS, UCB, Janssen Biotech and Abbott,

2;

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