Article Text

Download PDFPDF

SAT0138 A delay to diagnosis, but not to treatment initiation, in patients with rheumatoid arthritis (RA) is associated with ethnic group at one us academic site
  1. I. Castrejon1,
  2. T. Pincus1,
  3. J. Chua1,
  4. N. Shakoor1,
  5. S. Hassan1,
  6. J. A. Block1
  1. 1Rheumatology, Rush University Medical Center, Chicago, United States


Background: Disparities in the initiation of disease modifying antirheumatic drugs (DMARDs) therapy in ethnic minorities have been described in rheumatoid arthritis (RA)(1). These disparities are of particular concern in view of the emergence of early diagnosis and aggressive treatment as a cornerstone of management. Delays in diagnosis and treatment have been ascribed in part to lack of awareness, insidious onset, and atypical clinical presentation, but patient-dependent factors may be as important.

Objectives: To evaluate disparities in referral and initiation of treatment in RA patients at a USA academic rheumatology site.

Methods: We conducted a retrospective study and reviewed the medical records of patients with a primary diagnosis of RA seen at one USA academic setting (2011–2016). Among 642 RA patients, 50 received their initial evaluation by a rheumatologist during the observation period, and were naïve to any DMARD. Data extraction included time between first symptoms and initial visit to our rheumatology facility, demographics, family history, and laboratory tests. In addition, a Multidimensional-Health Assessment Questionnaire (MDHAQ) allowed us to calculate a RAPID3 score as the sum of 0–10 scores for a pain visual analogue scale (VAS), patient global VAS, and physical function. The time to initiation and type of DMARD prescribed after the first visit was also collected. Statistical analyses were performed using Kruskal-Wallis for differences between medians and chi-squared tests for comparisons between proportions according to ethnicity groups.

Results: Fifty new patients with RA were seen in the rheumatology outpatient clinic; 43% were White, 34% Black, and 23% Hispanic. The median delay to be seen by a rheumatologist was 7.2 months for White patients, 12 months for Black, and 11.9 months for Hispanic patients. There were no significant differences in time to initiation of DMARD according to ethnicity. Methotrexate was the DMARD most frequently prescribed, ranging from 86% in White patients to 60% in Hispanic patients. Disease severity according to RAPID3 scores was higher in Black and Hispanic groups, although laboratory tests did not differ between the 3 groups (Table).

Table 1

Patient characteristics by ethnicity

Conclusions: There is a considerable delay in initial referral to a rheumatologist, which appears to be more pronounced among Black and Hispanic patients. However, once seen in the clinic, initiation of DMARDs occurred within 1-month, regardless of ethnicity. These findings suggest that ethnic minorities are at risk of deleterious outcomes as a consequence of delayed presentation to a rheumatology setting.

Reference [1]Suarez-Almazor ME, et al. J Rheumatol2007;34(12):2400–07.

Disclosure of Interest: I. Castrejon: None declared, T. Pincus Shareholder of: Dr. Pincus holds a copyright and trademark.on MDHAQ and RAPID3 for which he receives royalties and license fees&x25A1;. All revenue is used to support further development of quantitative questionnaire measures for patients and doctors in clinical rheumatology care., J. Chua: None declared, N. Shakoor: None declared, S. Hassan: None declared, J. Block: None declared

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.