Background Delay in Rheumatoid Arthritis (RA) can be defined as the time between onset of RA symptoms and initiation of therapy. This delay is determined by patient, disease and physician related factors, but also by healthcare organization and referral pathways, as shown by differences across various countries1. A delay as short as 12-weeks in initiating therapy can positively influence treatment outcomes whereas longer delays can adversely affect outcomes2.
Objectives The aim of this study was to quantify delays in one Belgian academic center and to determine possible influencing factors.
Methods Seventy consecutive DMARD naive early RA patients were included. Seven kinds of delay were defined: patient delay (symptom onset as reported by patient -1st visit GP), patient delay according to GP (symptom onset according to GP - 1st visit GP), GP delay (1st visit GP - referral to rheumatologist), rheumatologist delay 1 (referral to and 1st screening by rheumatologist), rheumatologist delay 2 (1st screening by rheumatologist - start of treatment), total rheumatologist delay (referral to rheumatologist - start of treatment) and treatment delay (diagnosis - start of treatment). These delays combined form the total delay (symptom onset - start of treatment). The following potential determinants were registered: patient and GP demographics, disease characteristics and disease activity parameters. Their influence on delay was evaluated in a bivariate analysis.
The different delays are presented in the table above. Median total delay was 27 weeks whereas patient, GP and rheumatologist delay were 11, 2 and 7 weeks resp. 15,9% of the patients had a total delay ≤12 weeks.
Age of the GP was inversely related to GP delay (p=0,013). Patient delay was positively correlated with HAQ score (p=0,035). Total rheumatologist delay was inversely correlated with patient’s global assessment score (p=0,040). Total delay was inversely correlated with patient’s global assessment score, DAS28 ESR/CRP scores, HAQ score, TJC total/68/28 and SJC28 (all p-values <0,05). Patients employed before symptom onset had a longer total delay than unemployed patients (p=0,04). Currently employed patients had a longer total rheumatologist and rheumatologist delay 1 than unemployed patients (p=0,004 and p=0,006 resp.).
Conclusions For the majority of Belgian early RA patients in our academic setting, total delay exceeds the critical period of 12 weeks. Patient and rheumatologist delay contribute the most to overall delay. Data evaluating delay in non academic centers is underway and can contribute further to a better understanding of delay.
Raza K. et al. Delays in assessment of patients with rheumatoid arthritis: variations across Europe. Ann Rheum Dis. 2011:70(10): 1822-5.
Bosello S et al. Very early rheumatoid arthritis is the major predictor of major outcomes: clinical ACR remission and radiographic non-progression. Ann Rheum Dis. 2011;70(7):1292-5.
Disclosure of Interest None Declared