ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 1936

Referral and Diagnostic Delays of Patients with Chronic Inflammatory Rheumatic Diseases: A Cross-sectional Study in Eight Countries

Nelly Ziade1, Nizar Ani2, avin maroof3, ASAL ADNAN RIDHA4, Manal El Rakawi5, Chafika Haouichat5, Bassel Elzorkany6, Sherif Gamal7, Mariama Erraoui8, Manal Al-Mashaleh9, Fatima Alnaimat10, Basel masri11, fatemah Baron12, Lina El Kibbi13, Krystel Aouad14, Karen Mechleb15 and Ihsane Hmamouchi16, and ARCH ArLAR, 1Saint-Joseph University, Beirut, Lebanon, 2Baghdad College of Medicine, Baghdad, Iraq, 3University of Kurdistan Hawler, Erbil, Iraq, 4Baghdad Teaching Hospital, baghdad, Iraq, 5Djillali Bounaama University Hospital, Algiers, Algeria, 6Private (BZRC), Cairo, Egypt, 7Cairo University, Cairo, Egypt, 8Souss Massa Univeristy, Rabat, Morocco, 9Royal Medical Services, Amman, Jordan, 10The University of Jordan, amman, Jordan, 11Jordan Hospital and Medical Center, Amman, Jordan, 12Al-Jahra Hospital, Ministry of Health, Kuwait, Kuwait, 13Specialized Medical Center, Riyadh, Saudi Arabia, 14Saint George Hospital University Medical Center, Beirut, Lebanon, 15Saint Joseph University Beirut, Beirut, Lebanon, 16Rheumatology Unit, Lalla Aicha Temara Hospital, Temara, Rabat, Morocco

Meeting: ACR Convergence 2024

Keywords: , , ,

Session Information

Date: Monday, November 18, 2024

Title: Health Services Research – ACR/ARP Poster III

Session Type: Poster Session C

Session Time: 10:30AM-12:30PM

Background/Purpose: Patients with chronic inflammatory rheumatic diseases (CIRDs) may benefit from a critical window of opportunity for early intervention, yet referral delays remain a major barrier. While existing research explores these delays, data from Arab countries remains scarce. Considering the regional healthcare systems and cultural contexts, this study aims to evaluate the proportion of patients with CIRDs among all new referrals in 8 Arab countries. In addition, we estimated the diagnostic delay in new patients referred with CIRDs and assessed its associated factors.

Methods: Sixteen rheumatologists from 8 Arab countries provided their outpatient practice data about the new patients diagnosed with rheumatoid arthritis (RA), axial spondyloarthritis (axSpA) and psoriatic arthritis (PsA) and peripheral SpA (pSpA), and the number of all patients seen in their practice to serve as denominators. In addition, data about the consecutive new patients with CIRDs were collected: demographics, time periods between the first symptom, first consultation with any physician, with a rheumatologist, and CIRD diagnosis Data was presented descriptively (median time delay and interquartile range (IQR)), and factors associated with diagnostic delay were identified using a multivariable linear regression.

Results: In a sample of 2490 patients seen in November 2023, 746 (30%) were new patients; of those, 124 (17%) were diagnosed with RA, 94 (13%) with axSpA, and 16 (2%) with PsA and pSpA (CIRDs 9.4%). The proportion of new patients and those with CIRDs varied between the countries (10-62% and 7-73%, respectively). In addition, 393 files of consecutive newly referred patients with CIRDs in 2023 were reviewed, 183 RA (47%), 118 (30%) PsA and pSpA, and 92 (23%) axSpA. Their mean age was 44±15 years; 257 (65%) were females, 164 (42%) had a university education, and 201 (51%) were seen in a private setting. The median time (IQR) in months between the initial symptom on one hand and the first consultation with any physician, any rheumatologist, current rheumatologist, and diagnosis on the other hand was, respectively, 0.9 (0-12), 14 (4-40), 28 (10-78), and 18 (6-49) (Figure 1). In the opinion of the rheumatologist, 304 (77%) patients were delayed, and the main reasons were related to the primary care physician (PCP) in 188 (48%) and to the patient in 154 (39%). Factors associated with diagnostic delay in the multivariable analysis were seeing the patient in a public setting (p=0.005), and delay from the time of the first symptom to any physician (p< 0.001) and to any rheumatologist consultation (p< 0.001).

Conclusion: The proportion of new patients diagnosed with CIRDs among all outpatient consultations was 9.4% and varied across countries. The median diagnostic delay of 18 months highlights the need for improvement, particularly within the PCP-to-rheumatologist referral pathway. Delays associated with public healthcare settings and initial physician consultation suggest a multifaceted challenge. Addressing these challenges will help shape the future implementation of referral strategies for patients with CIRDs to rheumatology.

Supporting image 1

Figure 1. Key timelines in the journey of a patient with a chronic inflammatory rheumatic disease

Disclosures: N. Ziade: AbbVie/Abbott, 1, 6, Celgene, 5, Eli Lilly, 5, 6, Gilead, 5, Janssen, 5, 6, Pfizer, 5, 6, Roche, 1, 6; N. Ani: None; a. maroof: None; A. RIDHA: None; M. El Rakawi: None; C. Haouichat: None; B. Elzorkany: None; S. Gamal: None; M. Erraoui: None; M. Al-Mashaleh: None; F. Alnaimat: None; B. masri: None; f. Baron: None; L. El Kibbi: None; K. Aouad: None; K. Mechleb: None; I. Hmamouchi: None.

To cite this abstract in AMA style:

Ziade N, Ani N, maroof a, RIDHA A, El Rakawi M, Haouichat C, Elzorkany B, Gamal S, Erraoui M, Al-Mashaleh M, Alnaimat F, masri B, Baron f, El Kibbi L, Aouad K, Mechleb K, Hmamouchi I. Referral and Diagnostic Delays of Patients with Chronic Inflammatory Rheumatic Diseases: A Cross-sectional Study in Eight Countries [abstract]. Arthritis Rheumatol. 2024; 76 (suppl 9). https://acrabstracts.org/abstract/referral-and-diagnostic-delays-of-patients-with-chronic-inflammatory-rheumatic-diseases-a-cross-sectional-study-in-eight-countries/. Accessed .

« Back to ACR Convergence 2024

ACR Meeting Abstracts - https://acrabstracts.org/abstract/referral-and-diagnostic-delays-of-patients-with-chronic-inflammatory-rheumatic-diseases-a-cross-sectional-study-in-eight-countries/