Session Information
Session Type: ACR Poster Session A
Session Time: 9:00AM-11:00AM
Background/Purpose:
In early rheumatoid arthritis (RA), initiation of disease-modifying anti-rheumatic drugs (DMARD) within 12 weeks of symptom onset is associated with a significant benefit in long-term disease outcome. Our objective was to determine the proportion of patients with RA in whom DMARD therapy was initiated within the desired time frame.
Methods:
A retrospective chart review of adult patients diagnosed with RA during year 2014 was performed at the rheumatology department of an integrated secondary/tertiary teaching hospital, which provides rheumatology services for a population of more than 500.000 residents. Potential cases were identified by searching the electronic medical records for ICD-10 codes M05.* and M06.* Electronic and paper records of patients were then thoroughly reviewed. Cases fulfilling the 2010 ACR/EULAR classification criteria for RA were included in the analysis. Dates were recorded for onset of inflammatory joint symptoms, initial assessment by a rheumatologist and initiation of DMARD therapy. The percentage of patients treated with DMARD within 12 weeks of symptom onset and the median times for delay were then calculated.
Results:
Between January 1st 2014 and December 31st 2014, 87 new cases of RA were identified at our Department of Rheumatology. Within 12 weeks of symptom onset, 52% of new RA patients were examined by a rheumatologist and 38% of patients were started on DMARD therapy, median time to consultation was 9.9 weeks [IQR 4.4-25.2 weeks], median time to establishment of diagnosis was 12.7 weeks [IQR 5.9-25.9 weeks] and median DMARD treatment delay was 14.4 weeks [IQR 7.6-27.7 weeks]. The preferred DMARD agent was methotrexate (77%), followed by sulfasalazine (9%) and leflunomide (2%). 12% of patients were not prescribed DMARD treatment for various reasons (mainly non-compliance and advanced age).
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Table: Demographic data and clinical history |
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Gender (female/male) (%) |
78/22 |
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Age, years (mean ± SD) |
61.5 ± 15.2 |
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Tender joint count (mean ± SD) |
9.1 ± 7.6 |
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Swollen joint count (mean ± SD) |
8.7 ± 5.8 |
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Erythrocyte sedimentation rate (ESR), mm/h (mean ± SD) |
46 ± 23.3 |
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C-reactive protein (CRP), mg/l (mean ± SD) |
38 ± 44.0 |
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Positive rheumatoid factor, % |
62.1 |
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Positive anti-CCP, % |
67.8 |
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DAS28 3v (mean ± SD) |
5.4 ± 1.2 |
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Time from symptom onset to first rheumatologist assessment, weeks (median) |
9.9 (IQR, 4.4–25.2) |
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Time from symptom onset to DMARD initiation, weeks (median) |
14.4 (IQR, 7.6–27.7) |
Conclusion:
38% of new patients with RA were treated with a DMARD within the recommended time frame of 12 weeks. Most of the treatment delay was due to the time elapsed between symptom onset and consultation with a rheumatologist, suggesting the potential additional benefit of improved education of patients and primary care physicians.
To cite this abstract in AMA style:
Ješe R, Ambrožič A, Gaspersic N, Hocevar A, Lestan B, Plešivčnik Novljan M, Praprotnik S, Rotar Z, Šipek Dolničar A, Tomšič M. Time to Disease-Modifying Anti-Rheumatic Drug Treatment for New Patients with Rheumatoid Arthritis – Single Center Experience [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/time-to-disease-modifying-anti-rheumatic-drug-treatment-for-new-patients-with-rheumatoid-arthritis-single-center-experience/. Accessed .« Back to 2015 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/time-to-disease-modifying-anti-rheumatic-drug-treatment-for-new-patients-with-rheumatoid-arthritis-single-center-experience/