Background Very early referral/start of therapy within 3-4 months vs. delayed referral has been shown beneficial for short- and long-term outcomes in rheumatoid arthritis (RA). However, treatment strategy in these studies was not a stringent T2T approach. In FIN-RACo study, 2-year remission rates were 11% in monotherapy patients who had >4month-delay and 35% in patients who started therapy without delay within 4months after symptoms, while 42% of patients who received triple combination were in remission, regardless of delay of therapy indicating that early intensive therapy may overcome a delay.

Objectives To study whether delay of therapy affects outcomes of RA in a real life setting in a clinic with a T2T approach.

Methods A clinical database with data of all RA cases in a district of 275.000 population was analyzed for patients with a new diagnosis of RA in 1993-2013. Database includes variables for demographics, clinical course, outcomes, medications and the date of first symptoms of RA, a question which was asked from the patient at the first visit and recorded in the database. Duration of symptoms (delay) at initiation of therapy was categorized as 0-3mo, 4-6mo, 7-12mo, 13-24mo, and >2yr. Outcome variables and medication data were available in 60-68% of patients at a mean of 7.3 years after diagnosis.

Results In 1993-2013, 2374 patients (mean age 56yr, 67%F, 59%RF/CCP+) were diagnosed and treated with a median duration of symptoms of 5.5mo ranging from 4.5mo in 2005 to 7.4 in 2003 with no increasing/decreasing trend of delay over years. Existing musculoskeletal disease and younger age were associated with longer delay, adjusted for sero+/-, gender, and year of diagnosis. Overall, 32%, 24%, 24%, 10%, and 10% of patients had a delay of 0-3mo, 4-6mo, 7-12mo, 13-24mo, and >2yr, respectively. No significant differences in outcomes and treatments were observed between the delay groups after a mean follow-up of 7 years (Table 1).

Conclusions Delay of treatment start may have minor influence on outcomes in a T2T clinic.

References

1. Lard et al. AM J Med 2001.

2. Gremese at al. ARD 2013.

3. Ehrmann Feldman et al. Rheumatology 2013.

4. Möttönen et al. A&R 2002

Disclosure of Interest None declared

DOI 10.1136/annrheumdis-2014-eular.2245