Objectives The aims of this study were to establish delay times from articular symptoms onset to first rheumatologist consultation, rheumatoid arthritis (RA) diagnosis, and treatment initiation with disease-modifying antirheumatic drug (DMARD) therapy and to assess the impact of delayed diagnosis on structural damage. Methods This was an observational cohort study. Rheumatoid arthritis adult patients treated in a private health system between January 1, 1996, and December 31, 2016, were included. Electronic medical records were reviewed to obtain clinical and demographic data, dates of first disease symptom, diagnosis, and date of first treatment with DMARDs. Physical function (Health Assessment Questionnaire) and structural damage (Sharp score modified by van der Heijde) were also assessed. Results Two hundred forty-six patients (81% female), with a mean age of 67.25 (standard deviation [SD], 14.53) years, were included. At the end of follow-up period, median Health Assessment Questionnaire (n = 145) and radiological scores (n = 171) were 0.125 (interquartile range, 0–0.87) and 15 (interquartile range, 6–33), respectively. A mean of 9.2 (SD, 20) months (median, 3 months) elapsed from the first disease symptom to rheumatologist consultation, 14.2 (SD, 24) months (median, 4.8 months) to RA diagnosis, and 16.9 (SD, 25.4) months (median, 7 months) to treatment initiation with DMARDs. Significantly greater structural damage was found in patients with a diagnosis delay of more than 12 months (n = 70) (p = 0.0325). Conclusions Despite good access to medical consultation in a private health system, there is still a delay to RA diagnosis and to start pharmacological therapy. A delay of more than 12 months was significantly associated with greater radiological damage after 5 years of follow-up.

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BackgroundIt has been shown that there is a window of opportunity for treatment in Rheumatoid Arthritis (RA). Several Argentinean studies showed an average of 8 months to arrive to a rheumatology visit and 12 months to receive DMARDs. There aren't recent studies.ObjectivesTo establish delay time from onset of rheumatoid arthritis (RA) symptoms to the first rheumatology visit, to diagnosis of the disease and to the beginning of treatment with DMARDs; and to assess impact of such delay on structural damage, in a cohort of RA patients.MethodsA retrospective study was performed including all patients with RA (fulfilling ACR/EULAR 2010 criteria) seen at a Prepaid Medical Health Plan between 2002–2015. Diagnosis delay and its impact on functional capacity measured by HAQ-A and structural damage by Sharp van der Hejde score (SvdH) was estimated. Demographic and clinical data, and dates ofdiagnosis, onset of symptoms and HAQ-A were extracted from electronic medical records. Svdh score was performed by an experienced rheumatologist.Results246 patients (mean age at diagnosis 67.25±14 years, 199 (81%) female) were included. Clinical presentation was poliarticularin 49% of the cases, oligoarticularin 47% and monoarticular in 3%. 79% had high titers of anti-cyclic citrullinated peptide antibodies, 12% low titers, and 9% were negative. Rheumatoid factor was positive in 82.5%. Mean time of follow up was 7 years (SD: 3.8). At the end of the follow-up,median HAQ-A (n=145) was 0.125 (IRQ: 0–0.87). Hands and feet lastxray available were analized in 171 patients. Median Svdh score was 15 (IQR: 6–33). 242 patients (98.4%) received DMARDs as initial treatment: methotrexate monotherapy (76%) was the most frequent one. 41 patients (17%) received biological agents at some point of their disease. Table 1 shows different delay times in accessing rheumatology consultation, diagnosis and beginning of treatment.At the end of follow up, 21 patients (12.28%) had noradiological damage (Svdh score =0). In the ROC curve (AUC 0.57,95% CI: 0.45 - 0.69), 5.6 months of diagnosis delay was the best cut off valueto discriminate the presence of erosions (SvdH erosions score>0), with a sensitivity and specificity of 54.17% and 61.90%, respectively. Delay in diagnosis greater than 12 months (n=70) was associated with significantly radiological damage: Svdh mean 30.91 (IC 95% 21.99–39.79) vs 21.32 (IC 95% 16.93–25.72); p=0.0325.Table 1.different delay timesVariableMean (SD)Median (IQR) Time from first symptoms to first rheumatology visit (months)9.21 (20.50)3 (1–7)Time from first symptoms to diagnosis (months)14.2 (24)4.8 (2.4–13)Time fromfirst symptoms to DMARDs indication (months)16.9 (25.4)7 (3–17)Time from first symptoms to biological indication (years)6.2 (4.8)5.7 (2.4–7.2)ConclusionsIn a Prepaid Medical Health Planwith ease of referral, there is still a significant delay in diagnosis and treatment of RA patients.Delay in diagnosis greater than 12 months was associated with more radiological damage.Disclosure of InterestNone declared