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Delays in assessment of patients with rheumatoid arthritis: variations across Europe
  1. Karim Raza1,2,3,
  2. Rebecca Stack1,2,
  3. Kanta Kumar1,2,
  4. Andrew Filer1,2,3,
  5. Jacqueline Detert4,
  6. Hans Bastian4,
  7. Gerd R Burmester4,
  8. Prodromos Sidiropoulos5,
  9. Eleni Kteniadaki5,
  10. Argyro Repa5,
  11. Tore Saxne6,
  12. Carl Turesson6,
  13. Herman Mann7,
  14. Jiri Vencovsky7,
  15. Anca Catrina8,
  16. Aikaterini Chatzidionysiou8,
  17. Aase Hensvold8,
  18. Solbritt Rantapää-Dahlqvist9,
  19. Alexa Binder10,
  20. Klaus Machold10,
  21. Brygida Kwiakowska11,
  22. Adrian Ciurea12,
  23. Giorgio Tamborrini12,
  24. Diego Kyburz12,
  25. Christopher D Buckley1,2,3
  1. 1Rheumatology Research Group, MRC Centre for Immune Regulation, Institute for Biomedical Research, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
  2. 2Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
  3. 3Department of Rheumatology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
  4. 4Department of Rheumatology and Clinical Immunology, Charité – Universitätsmedizin Berlin, Berlin, Germany
  5. 5Department of Rheumatology, Clinical Immunology and Allergy, Medical School, University of Crete, Crete, Greece
  6. 6Department of Clinical Sciences, Section of Rheumatology, Lund University, Skåne University Hospital, Lund, Sweden
  7. 7Institute of Rheumatology and Department of Rheumatology, Charles University, Prague, Czech Republic
  8. 8Rheumatology Unit, Department of Medicine, Karolinska Institute and Karolinska University Hospital, Solna, Sweden
  9. 9Department of Public Health and Clinical Medicine, Rheumatology, University Hospital, Umeå, Sweden
  10. 10Department of Rheumatology, Medical University of Vienna, Vienna, Austria
  11. 11Department of Early Arthritis Diagnosis, Institute of Rheumatology, Warsaw, Poland
  12. 12Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland
  1. Correspondence toDr Karim Raza, Rheumatology Research Group, MRC Centre for Immune Regulation, Institute for Biomedical Research, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK; k.raza{at}


Objective The first 3 months after symptom onset represent an important therapeutic window for rheumatoid arthritis (RA). This study investigates the extent and causes of delay in assessment of patients with RA in eight European countries.

Method Data on the following levels of delay were collected from 10 centres (Berlin, Birmingham, Heraklion, Lund, Prague, Stockholm, Umeå, Vienna, Warsaw and Zurich): (1) from onset of RA symptoms to request to see healthcare professional (HCP); (2) from request to see HCP to assessment by that HCP; (3) from initial assessment by HCP to referral to rheumatologist; and (4) from referral to rheumatologist to assessment by that rheumatologist.

Results Data were collected from 482 patients with RA. The median delay across the 10 centres from symptom onset to assessment by the rheumatologist was 24 weeks, with the percentage of patients seen within 12 weeks of symptom onset ranging from 8% to 42%. There were important differences in the levels underlying the total delays at individual centres.

Conclusions This research highlights the contribution of patients, professionals and health systems to treatment delay for patients with RA in Europe. Although some centres have strengths in minimising certain types of delay, interventions are required in all centres to ensure timely treatment for patients.

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  • Funding This work has been supported by a grant from the European Community's Sixth Framework Programme (AutoCure). The Prague centre was supported by a grant NR 10065-4 from the Internal Grant Agency of the Ministry of Health of the Czech Republic.

  • Ethics approval This study was conducted with the approval of the research ethics committee in the Czech Republic. In the other countries the regulatory authorities determined that the collection of these anonymous data constituted a service evaluation for which approval from a research ethics committee was not necessary.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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