Lag time between onset of symptoms and diagnosis in Venezuelan patients with rheumatoid arthritis

Abstract

A retrospective study in a hospital-based sample of Venezuelan patients with rheumatoid arthritis was made to estimate the lag time between onset of symptoms, diagnosis, and initiation of DMARD treatment. Medical records and in-person interview of patients to fill in a questionnaire collecting information on demographics and initiation of symptoms, first consultation with any physician, time of diagnosis, and initiation of first disease-modifying anti-rheumatic drug were reviewed. We performed descriptive statistics and multivariable linear regression analysis. Mean lag time between symptom onset and diagnosis of rheumatoid arthritis was 40.5 months (range 1-424). Mean lag time between onset of symptoms and first consultation with a physician and between first consultation and diagnosis was 16.3 and 23.9 months, respectively. Mean lag time between onset of symptoms and initiation of DMARD treatment was 56.9 months. A definitive diagnosis of rheumatoid arthritis was done by a rheumatologist in 251 patients (92.3%). First consultation with an orthopedist or a primary care physician, first consultation in a public versus a private health center, and diagnosis before 2000 were associated with longer lag time between onset of symptoms and diagnosis. Venezuelan patients with rheumatoid arthritis had a marked delay from disease onset to diagnosis and initiation of first DMARD. First consultation with an orthopedist and consultation in a public versus a private health center were the variables with the strongest effect on lag time to diagnosis and to initiation of first DMARD.

Use of complementary and alternative medicines is associated with delay to initiation of disease‐modifying anti‐rheumatic drug therapy in early inflammatory arthritis

“…Overall, patients in our cohort initiated DMARD at a median of 17.4 (10.6–27.1) weeks from symptom onset. While this is more than the recommended 12 weeks, it compares favorably with other early arthritis cohorts in developed countries and is much shorter than that reported in developing countries . Previous studies have suggested lower socioeconomic status (SES), lower number of swollen joints, seropositivity and presence of other comorbid conditions such as fibromyalgia and osteoarthritis to be associated with delayed presentation .…”

“…While this is more than the recommended 12 weeks, it compares favorably with other early arthritis cohorts in developed countries and is much shorter than that reported in developing countries. 3,36,37 Previous studies have suggested lower socioeconomic status (SES), lower number of swollen joints, seropositivity and presence of other comorbid conditions such as fibromyalgia and osteoarthritis to be associated with delayed presentation. [38][39][40][41] In our study, education level and being non-English speaking were used as surrogates for SES; however, these were not associated with increased delay to DMARD prescription.…”

Incident Heart Failure in Patients With Rheumatoid Arthritis: A Nationwide Cohort Study

“…Indeed, a register‐based Swedish study found a 22% to 27% increased risk of HF in patients with RA, with the increased risk being similar for those with ischemic versus nonischemic HF and strongest for subjects positive for rheumatoid factor, respectively 20. Notably, RA is a chronic disease and there is often a significant delay from onset of symptoms to first healthcare visit and diagnosis 39, 40. To give a better representation of patients with RA in the general population, we therefore chose a prevalent study design for our main analysis, where we did not exclude patients with a history of RA before the study start.…”

“…20 Notably, RA is a chronic disease and there is often a significant delay from onset of symptoms to first healthcare visit and diagnosis. 39,40 To give a better representation of patients with RA in the general population, we therefore chose a prevalent study design for our main analysis, where we did not exclude patients with a history of RA before the study start. However, we also performed a sensitivity analysis where we reported IRRs for new-onset RA with a maximum follow-up of 11 years and found comparable results.…”

“…RA is a chronic disease, and, consequently, there is a marked delay from onset of symptoms to first (in-patient or out-patient) consultation and diagnosis. 39 Moreover, studies have shown that patients with RA with longer disease duration have a higher risk of cardiovascular adverse events compared with those with shorter disease duration. 40 Thus, an inception study design, where subjects with prevalent RA are excluded at baseline, may underestimate the true RA-related effect.…”