Does Delay Matter in Early Rheumatoid Arthritis?

Abstract

Aims: The aims of this study were to explore the effect of delayed presentation to a rheumatologist on the clinical outcomes in patients with early rheumatoid arthritis (RA) after 2 years of follow-up and to determine the predictors of failure to achieve therapeutic targets in those patients. Methods: It is a retrospective study; patients were recruited from Dubai Arthritis Registry (DAR). All patients with symptoms of RA <6months, who attended early arthritis clinic and subsequently completed a follow-up of 2 years in the general rheumatology clinic, were included in the study. We extracted clinical and demographic data from DAR. Results: We have enrolled 78 patients with ERA. Their median age was 49 years (interquartile range [IQR]: 34–52) years, 88.5% were female and 5.2% were current or past smokers. The median delay between symptom onset and seeing a rheumatologist was 34 (IQR: 13–71) days. About 75.4% achieved clinical targets at 24 months of follow-up. Seventy per cent had a good response, 14% had a moderate response and 16% had no response. The proportion of non-responder was higher in the delayed group than those who presented early after the onset of symptoms (odds ratio = 2.6, 95% confidence interval: 1.2–5.9 and P = 0.02). Female gender, Anti-Citrullinated Protein Antibodies (ACPA) positive and Disease Activity Score 28 (DAS28) at baseline are independent predictors of achieving clinical targets after 2-year follow-up. Conclusion: Delayed presentation to rheumatologist adversely affects the clinical outcomes in patients with early RA. Indeed, female gender, DAS28 at baseline and ACPA positivity remain independent predictors of achieving clinical outcomes in patients with ERA.

Keywords

• disease activity score 28
• early rheumatoid arthritis
• gender
• referral