RESEARCH - Long-term impact of delay in assessment of early arthritis patients

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Arthritis Rheum. 2010 Aug 18.

Long-term impact of delay in assessment of early arthritis patients.

van der Linden MP, Cessie SL, Raza K, Woude DV, Knevel R, Huizinga TW,

van der Helm-van Mil AH.

Department of Rheumatology, Leiden University Medical Center, Leiden,

The Netherlands.

Abstract

BACKGROUND: During the last decade rheumatologists have learned to

initiate disease-modifying-antirheumatic-drugs (DMARDs) early to

improve outcome of rheumatoid arthritis (RA). The effect of delay in

referral to rheumatologists on the outcome of RA is scarcely explored.

We studied the association between delay in assessment by

rheumatologists, rates of joint destruction, and probability of

achieving DMARD-free-remission in RA. Patient characteristics

associated with the patient and general practitioner (GP)-components

of overall delay were assessed.

METHODS: 1674 early arthritis-patients from the Leiden EAC were

studied on patient, GP-, and total delays. Within 598 RA-patients,

associations between total delay, achievement of

sustained-DMARD-free-remission, and the rate of joint destruction over

six years follow-up were determined.

RESULTS: The median patient, GP-, and total delays in early

arthritis-patients were 2.4, 8.0 and 13.7 weeks respectively. From all

diagnoses, early arthritis-patients diagnosed with RA or

spondylarthropathy had the longest total delay (18 weeks). 69% of

RA-patients were assessed in >/=12 weeks; this was associated with a

hazard ratio of 1.87 for not achieving DMARD-free remission and a 1.3

times higher rate of joint destruction over six years compared to

assessment <12 weeks. Older age, female gender, gradual symptom-onset,

small-joint involvement, lower CRP-levels, and autoantibody-presence

associated with longer total delay.

CONCLUSION: Only 31% of RA-patients were assessed <12 weeks.

Assessment <12 weeks is associated with less joint destruction and a

higher chance on DMARD-free remission compared to a longer delay in

assessment. These results imply that attempts to diminish delay in

seeing rheumatologists will improve disease outcome in RA.

PMID: 20722031

http://www.ncbi.nlm.nih.gov/pubmed/20722031

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