AB0194 Journey of a patient with rheumatoid arthritis: delay in diagnosis and treatment

Abstract

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