From Symptoms to Diagnosis: An Observational Study of the Journey of Rheumatoid Arthritis Patients in Saudi Arabia

Hussain, Waleed; Noorwali, Abdulsalam; Janoudi, Nahid; Baamer, Maatouqa; Kebbi, Lina; Mansafi, Hanady; Ibrahim, Ashraf; Gohary, Shereen; Minguet, Joan; Almoallim, Hani

doi:10.5001/omj.2016.06

Cited by 32 publications

(52 citation statements)

References 23 publications

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“…Previous studies conducted in other Brazilian cities showed a diagnostic time of approximately 8 [17], 12 [18] and 39 months [9], showing that the present study is within the national intervals, and presented similarity to a study in Brasília, whose time was 27 months [19]. The international literature offers a variety of data, such as a mean time of 6 months in European countries [20], 30 months in Saudi Arabia [7] and up to 33 months in Colombia [21]. These data show that there are contributing factors for the diagnostic time that differ according to locality.…”

Section: Discussionsupporting

confidence: 82%

“…Despite this, the world reality differs from that recommended. In Saudi Arabia, an average time of approximately 30 months was verified [7], whereas in England, the ERAN study found a period of approximately 4 months for the diagnosis [8]. In Brazil, a study from São Paulo verified that the average waiting time between the beginning of the symptoms and rheumatologic evaluation was on average 39 months .…”

Section: Introductionmentioning

confidence: 99%

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Prevalence and factors associated with diagnosis of early rheumatoid arthritis in the south of Brazil

2018

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Background: Rheumatoid arthritis (RA) is an autoimmune inflammatory disease characterized by peripheral and symmetrical polyarthritis. It can be divided into Very Early Rheumatoid Arthritis (VERA) diagnosed up to 3 months of symptoms and late onset (Late Early Rheumatoid Arthritis-LERA), diagnosed between 3 and 12 months. Currently, it is recommended to evaluate the patient with joint symptoms as early as possible, and the first 12 weeks of manifestations represent the ideal phase for the diagnosis, favoring a better evolution of the treatment. The present study aimed to determine the prevalence of early diagnosis of rheumatoid arthritis, mean time of diagnosis and to determine possible associated factors in the municipality of Blumenau, Santa Catarina, Brazil. Methods: A cross-sectional study using the 1987 American College of Rheumatology diagnostic criteria to select patients attended at primary or secondary health care units in Blumenau, Santa Catarina, southern Brazil, in 2014. Diagnostic time was verified by self-report of the time elapsed between the onset of symptoms and the diagnosis made by a rheumatologist. To test the associations, the chi-square test, the Wald linear trend test and the Poisson regression analysis were used. Results: The mean time of diagnosis was 28 months. The prevalence of diagnosis up to 3 and 12 months was 27. 7% and 64.8%, respectively. Obesity was associated with time diagnosis in both periods. The 0-4 years category of the variable education was associated only with the period up to 12 months. Conclusion: The mean time of diagnosis was similar to the national context. Among socioeconomic factors, lower education was associated with the diagnosis of late onset RA. The anthropometric variable presented a progressive increase in the prevalence due to the longer time to diagnosis.

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Section: Discussionsupporting

confidence: 82%

Section: Introductionmentioning

confidence: 99%

Prevalence and factors associated with diagnosis of early rheumatoid arthritis in the south of Brazil

2018

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“…A recent study performed in Saudi Arabia found that patients consulted an average of 4 physicians between their first symptom of RA and final diagnosis, with a mean time from the first physician visit to final RA diagnosis of ~30 months. 14 Although patients consulted with physicians at a mean of 7 months after the onset of RA symptoms, very few subjects initially sought a consultation with rheumatologists, who were ultimately responsible for diagnosing most RA patients.…”

Section: Introductionmentioning

confidence: 99%

The journey of rheumatoid arthritis patients: a review of reported lag times from the onset of symptoms

Barhamain¹,

Magliah²,

Shaheen³

et al. 2017

OARRR

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BackgroundEven after achieving tremendous advances in diagnosis and treatment of rheumatoid arthritis (RA), many of the patients undergo delays in diagnosis and initiation of treatment, which leads to worsening of the condition and poor prognosis.ObjectiveThe objective of this study was to perform a literature review to quantify the lag times in diagnosis and treatment of RA and study the reported factors associated with it.MethodsThe authors searched literature published until September 2016 in electronic full-text and abstract databases and hand-searched the suitable articles.ResultsThe weighted average of median lag time from symptom onset to therapy was 11.79 months (12 studies, 5,512 patients, range 3.6–24.0 months). Lag1 was 3.14 months (onset of symptoms to first physician consultant; 12 studies, 6,055 patients, range 0–5.7 months); lag2 was 2.13 months (physician visit to RA specialist referral; 13 studies, 34,767 patients, range 0.5–6.6 months); lag3 was 2.91 months (consultation with rheumatologist to diagnosis; 3 studies, 563 patients, range 0–5 months), lag4 was 2.14 months (diagnosis to initiation of disease-modifying antirheumatic drug therapy; 5 studies, 30,685 patients, range 0–2.2 months). Numerous patient-and physician-related factors like gender, ethnicity, primary care physician knowledge of the condition, availability of diagnostics, and so on were responsible for the delays.ConclusionThis review estimated the delay times and identified the main factors for delay in RA patients in diagnosis and initiation of treatment. A most plausible solution to this is coordinated effort by the rheumatology and primary care physicians.

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“…The time between symptom onset and diagnosis of rheumatoid arthritis by a rheumatologist in Saudi Arabia has been reported to be as high as 30 months 16. In comparison, a French study calculated an average of 53 days between PCP visit and rheumatologist assessment 17.…”

Section: Discussionmentioning

confidence: 99%

Determining early referral criteria for patients with suspected inflammatory arthritis presenting to primary care physicians: a cross-sectional study

Almoallim

Janoudi

Attar

et al. 2017

OARRR

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ObjectiveEarly diagnosis and initiation of treatment for inflammatory arthritis can greatly improve patient outcome. We aimed to provide standardized and validated criteria for use by primary care physicians (PCPs) in the identification of individuals requiring referral to a rheumatologist.Patients and methodsWe analyzed the predictive value of a wide variety of demographic variables, patient-reported complaints, physical examination results, and biomarkers in order to identify the most useful factors for indicating a requirement for referral. Patients for this cross-sectional study were enrolled from various centers of the city of Jeddah, Saudi Arabia, if they were ≥18 years of age and presented to a PCP with small joint pain that had been present for more than 6 weeks. A total of 203 patients were enrolled, as indicated by the sample size calculation. Each patient underwent a standardized physical examination, which was subsequently compared to ultrasound findings. Biomarker analysis and a patient interview were also carried out. Results were then correlated with the final diagnosis made by a rheumatologist.ResultsA total of 9 variables were identified as having high specificity and good predictive value: loss of appetite, swelling of metacarpophalangeal joint 2 or 5, swelling of proximal inter-phalangeal joint 2 or 3, wrist swelling, wrist tenderness, a positive test for rheumatoid factor, and a positive test for anti-citrullinated protein antibodies.ConclusionNine variables should be the basis of early referral criteria. It should aid PCPs in making appropriate early referrals of patients with suspected inflammatory arthritis, accelerating diagnosis and initiation of treatment.

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From Symptoms to Diagnosis: An Observational Study of the Journey of Rheumatoid Arthritis Patients in Saudi Arabia

Abstract: Failure of patients to be seen by rheumatologists at RA onset delayed diagnosis and treatment. Thus, RA diagnosis can be accelerated by encouraging early referral to rheumatologists.

Cited by 32 publications

References 23 publications

Prevalence and factors associated with diagnosis of early rheumatoid arthritis in the south of Brazil

Prevalence and factors associated with diagnosis of early rheumatoid arthritis in the south of Brazil

The journey of rheumatoid arthritis patients: a review of reported lag times from the onset of symptoms

Determining early referral criteria for patients with suspected inflammatory arthritis presenting to primary care physicians: a cross-sectional study

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