Impact of early diagnosis on functional disability in rheumatoid arthritis

Abstract

Background/AimsTo determine whether early diagnosis is beneficial for functional status of various disease durations in rheumatoid arthritis (RA) patients.MethodsA total of 4,540 RA patients were enrolled as part of the Korean Observational Study Network for Arthritis (KORONA). We defined early diagnosis as a lag time between symptom onset and RA diagnosis of ≤ 12 months, whereas patients with a longer lag time comprised the delayed diagnosis group. Demographic characteristics and outcomes were compared between early and delayed diagnosis groups. Logistic regression analyses were performed to identify the impact of early diagnosis on the development of functional disability in RA patients.ResultsA total of 2,597 patients (57.2%) were included in the early diagnosis group. The average Health Assessment Questionnaire-Disability Index (HAQ-DI) score was higher in the delayed diagnosis group (0.64 ± 0.63 vs. 0.70 ± 0.66, p < 0.01), and the proportion of patients with no functional disability (HAQ = 0) was higher in the early diagnosis group (22.9% vs. 20.0%, p = 0.02). In multivariable analyses, early diagnosis was independently associated with no functional disability (odds ratio [OR], 1.19; 95% confidence interval [CI], 1.01 to 1.40). In a subgroup analysis according to disease duration, early diagnosis was associated with no functional disability in patients with disease duration < 5 years (OR, 1.37; 95% CI, 1.09 to 1.72) but not in patients with longer disease duration (for 5 to 10 years: OR, 1.07; 95% CI, 0.75 to 1.52; for ≥ 10 years: OR, 0.92; 95% CI, 0.65 to 1.28).ConclusionsEarly diagnosis is associated with no functional disability, especially in patients with shorter disease duration.

Treat-to-Target Strategy for Asian Patients with Early Rheumatoid Arthritis: Result of a Multicenter Trial in Korea

“…However, better functional outcomes and the prevention of joint damage and disability can reduce long-term medical costs 22. Consistent with our finding, low DAS28-ESR is associated with low KHAQ score in a large Korean RA cohort (KORONA) 23…”

Factors associated with time to diagnosis from symptom onset in patients with early rheumatoid arthritis

“…Early diagnosis of RA is associated with decreased radiologic progression or functional disability [4,17]. In our study, the frequency of hand joint erosion was lower in the early diagnosis group than in the late diagnosis group, although their disease durations were similar.…”

“…Early diagnosis is an optimal target for better outcomes in rheumatoid arthritis (RA) in clinical practice [1,2], because early treatment is associated with improved outcomes [2-4]. Furthermore, a UK National Audit Office report concluded that initial management in secondary care of adopting an early diagnosis approach was more cost-effective compared to general physician referral [5].…”

Trends in Prevalence of Functional Disability in Rheumatoid Arthritis Compared With the General Population

“…Two large cohort studies from Europe recently reported lack of improvement in physical functioning based on HAQ score in patients with inflammatory arthritis in the new millennium versus those diagnosed in previous decades [6][7] . While higher disease activity and delayed RA diagnosis has been linked to increased likelihood of disability [8][9] , the persistent FD excess appears to be despite the improvements in RA disease activity and RA management [6][7]10 . The growing burden of mental and somatic comorbidity and pain, use of glucocorticoids and antidepressants, and increasing expectations for optimal physical functioning are possible reasons for the lack of improvement in FD in RA [6][7][11][12][13] .…”