Delayed exam tied to more joint destruction, lower chance of DMARD-free remission
WEDNESDAY, Dec. 1 (HealthDay News) -- Delayed assessment of rheumatoid arthritis (RA) patients appears to be associated with more joint destruction and a lower probability of a disease-modifying antirheumatic drug (DMARD)-free remission, but there is still a delay to assessment of at least 12 weeks in more than two-thirds of patients, according to a study published in the December issue of Arthritis & Rheumatism.
Michael P.M. van der Linden, M.D., of the Leiden University Medical Center in the Netherlands, and colleagues evaluated 1,674 early arthritis patients to assess the impact of patient, general practitioner, and total delays in referral to a rheumatologist. In addition, associations between total delay, achievement of sustained-DMARD-free-remission, and the rate of joint destruction were examined among 598 RA patients over six years of follow-up.
The investigators found that the median patient delay in early arthritis patients was 2.4 weeks and the general practitioner and total delays were 8.0 and 13.7 weeks, respectively. Early arthritis patients diagnosed with RA or spondylarthropathy had the longest total delay (18 weeks), with older age, female gender, gradual symptom-onset, small-joint involvement, lower C-reactive protein levels, and autoantibody presence associated with longer total delay. The investigators also found that 69 percent of RA patients were assessed in ≥12 weeks, which was associated with a hazard ratio of 1.87 for not achieving DMARD-free remission and a 1.3 times higher rate of joint destruction over six years, compared to assessment at less than 12 weeks.
"The lack of coordination of developing recommendations to identify patients early, using effective strategies for referral, contributes to the phenomenon of delay in timely care as demonstrated by van der Linden et al," write the authors of an accompanying editorial.
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