Background The reduction of the diagnostic delay in patients with early arthritis, in order to start treatment as early as possible and to improve outcomes, has required a considerable effort during the last 15 years.
Objectives To evaluate the diagnostic delay, between 2004 and 2015, at our Early Arthritis Clinic (EAC).
Methods 943 patients with rheumatoid arthritis (RA) (according to 1987 and/or 2010 classification criteria) or undifferentiated arthritis (UA) evaluated at our EAC between September 2004 to September 2015 were recruited (disease duration <12 months) and divided into 2 groups according to the time of diagnosis (group 1: 2004–2009; group 2: 2010–2015). A comparison among demographic features, diagnostic delay and disease activity (DAS28) at first evaluation was performed.
Results A total of 943 patients were evaluated: 469 patients into the group 1 (74.4% women, mean age 58 ys) vs. 474 patients into the group 2 (74.7% women, mean age 57 ys). No differences were found in terms of serologic positivity and diagnosis. At baseline, patients in the group 2 showed lower disease activity as for DAS28 (4.86±1.17 vs. 4.32±1.24; p=0.0001), number of tender joints (6 IQR 2–11 vs. 4 IQR 2–8; p=0.0001), swollen joints (6 IQR 4–11 vs. 4 IQR 2–7; p=0.0001), ESR (22 IQR 13–40 vs. 16,5 IQR 8–33; p=0.0001). In contrast, patients in the group 1 showed lower time from the onset of symptoms to the diagnosis (111 days IQR 67–200 vs. 129 IQR 77–228; p=0.008). Data about the diagnostic delay comparing DAS28 categories are showed in figure 1: particularly in the group 2 there was a reduction in the number of patients in high disease activity-DAS28 who have the diagnosis established within the first 90 days after the onset of the disease (p=0,0026). 40% of patients in group 1 vs. 31% in group 2 had the diagnosis established within 90 days (p=0.005); however, the delay from the referral to the first evaluation at our EAC was similar in the two groups (21 days IQR 12–31 vs. 21 IQR 14–29; p=ns).
Conclusions Currently, about 70% of the diagnosis is still not made within the so-called window of opportunity (90 days from the onset of symptoms). Moreover, a slight but significant worsening in the diagnostic delay has been observed; the delay doesn't seem to be related neither with time elapsing from referral to the first evaluation at the EAC nor to a lower disease activity at the beginning. Education programs at patients' and general practitioners' level should be implemented in order to reduce the delay and further improve the outcome.
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Van der Linden MP, et al. Long-term impact of delay in assessment of patients with early arthritis. Arthritis Rheum. 2010;62:3537–46.
Disclosure of Interest None declared