Session Information
Date: Sunday, November 5, 2017
Title: Rheumatoid Arthritis – Clinical Aspects Poster I: Treatment Patterns and Response
Session Type: ACR Poster Session A
Session Time: 9:00AM-11:00AM
Background/Purpose: there is a wide variation in the time elapsed between first symptoms and diagnosis of RA, ranging from 1 month to 10 years in different studies; data from Latin America populations are scarce.
Objective: to establish the lag times between articular symptoms onset and first rheumatologist consultation, Rheumatoid Arthritis (RA) diagnosis and treatment with disease-modifying antirheumatic drugs (DMARDs), and to assess the impact of delay on radiologic structural damage.
Methods: electronic Medical Records of a cohort of RA adult patients, attending a Private Health Care System (PHCS) between 01/01/1996 and 31/12/2016, were retrospectively reviewed. Clinical and demographic data, and dates of first disease symptoms, diagnosis of RA and starting treatment with DMARDs were obtained. Physical function was assessed by Health Assessment Questionnaire (HAQ). Radiologic structural damage was assessed by Sharp score modified by van der Heijde (SvdH score). For the logistic multivariable analysis, radiologic structural damage was defined as the presence of any value greater than 0 on SvdH score.
Results: 246 patients (81% female), with a mean age of 67.25 (SD:14.53) years, were included. Rheumatoid factor was positive in 82.5% and anti–citrullinated peptide antibodies in 91% of patients.
At the end of follow-up (mean: 7 years, SD: 3.8), median HAQ and SvdH were 0.125 (IQR: 0-0.87) and 15 (IQR: 6-33), respectively. Mean lag time between first disease symptom and rheumatologist consultation was 9.2 months [(SD:20) (median: 3 months)], mean lag time to RA diagnosis was 14.2 months [(SD: 24) (median: 4.8 months)] and was16.9 months [(SD: 25.4) (median: 7 months)] for starting treatment with DMARDs (Table).
Table. Delay times in consultations, diagnosis and treatment with DMARDs in RA patients.
|
Mean (SD) |
Median (IQR) |
|
|
Time elapsed from the beginning of symptoms to first health professional consultation (months) |
8.5 (21.6) |
1.8 (0.6-5.1) |
|
Time elapsed from the beginning of symptoms to first rheumatologist consultation (months) |
9.2 (20.5)
|
3 (1.2-7.1)
|
|
Time elapsed from the beginning of symptoms to RA diagnosis (months) |
14.2 (24)
|
4.8 (2.4-13)
|
|
Time elapsed from the beginning of symptoms to starting DMARDs therapy (months). |
16.9 (25.4) |
7 (3-17) |
More radiologic structural damage was observed in patients with more than 12 months delayed diagnosis of RA (mean SvdH score: 30.9 vs. 21.3, p = 0.0325). The presence of radiologic structural damage was associated with more than 12 months delayed diagnosis in logistic multivariable analysis (OR: 1.7 CI 95% 1.3-4.9, p=0.04).
Conclusion: in this cohort of RA patients from a PHCS there was a significant delay to achieve RA diagnosis and starting DMARDs therapy. A delay greater than12 months was associated with radiologic structural damage during the follow-up period.
To cite this abstract in AMA style:
Luissi A, Pierini F, Garcia MV, Sabelli M, Scolnik M, Ruta S, Rosa J, Soriano ER. Rheumatoid Arthritis Patient´s Journey: Delay in Diagnosis and Treatment [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/rheumatoid-arthritis-patients-journey-delay-in-diagnosis-and-treatment/. Accessed .« Back to 2017 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/rheumatoid-arthritis-patients-journey-delay-in-diagnosis-and-treatment/