Article Text

AB0297 Does Delay of Therapy Affect Outcomes of Early RA in A T2T Clinic?
  1. T. Sokka-Isler1,
  2. H. Kautiainen1,
  3. T. Rannio2,
  4. J. Asikainen1,
  5. P. Hannonen1
  1. 1Jyväskylä Central Hospital, Jyväskylä
  2. 2Kuopio Univ Hosp, Kuopio, Finland


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).

Table 1

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


  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

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.