Improved Long-Term Outcomes With Early Diagnosis, Treatment in RA

Early access to diagnosis and treatment of rheumatoid arthritis (RA) linked to improved long-term clinical outcomes, according to study findings published in Advances in Rheumatology.

In an observational study, researchers sought to examine the timing of assessment by a rheumatologist and how it affects the diagnosis of RA and the initiation of disease-modifying antirheumatic drug (DMARD) treatment, as well as the impact of timing on long-term RA control, in real-world settings.

Data from the REAL study were included in the analysis, which evaluated patterns of clinical management for patients with RA in a real-life setting from outpatient clinics in different regions of Brazil between August 2015 and 2016.

Inclusion criteria included adults who met the American College of Rheumatology/European Alliance of Associations for Rheumatology (ACR/EULAR) 2010 or the American Rheumatism Association (ARA) 1987 criteria for RA. The evaluation, conducted by a rheumatologist, was considered “early” if it was the first or second medical consultation after the onset of symptoms and “late” if the consultation occurred after that. Researchers also investigated delays in the diagnosis and treatment of RA.

Disease activity and physical function were measured using Disease Activity Score-28 (DAS28) and Health Assessment Questionnaire Disability Index (HAQ-DI).

A total of 1057 participants were included in this study, with a mean age of 56.9 (SD, 11.5) years and a mean disease duration of 173.1 (SD, 114.5) months. The median time for an RA diagnosis and initial treatment was 12 months.

The majority of participants (64.6%) initially sought evaluation from their general practitioner; however, 80.7% received a confirmed diagnosis from a rheumatologist. Less than one-thirds (28.7%) of patients received early treatment (within 6 months of experiencing symptoms) for RA.

The delay in diagnosing and treating RA was found to be strongly correlated (correlation coefficient [rho], 0.816; P <.001). The likelihood of missing early treatment more than doubled when the evaluation by the rheumatologist was delayed (odds ratio [OR], 2.77; 95% CI, 1.93-3.97).

Participants who were assessed early vs late showed better DAS28 and HAQ-DI scores (difference in means, -0.25 [95% CI, -0.46 to -0.04] and -0.196 [95% CI, -0.306 to -0.087], respectively). Participants who received a “late” assessment had a lower risk of achieving low disease activity or remission (OR, 0.74; 95% CI, 0.55-0.99; P =.045).

Study limitations included the observational design, which may have resulted in biases, and the dependence on patients’ recall on the delays in diagnosis and treatment.

Researchers concluded, “When not confident about the diagnosis or management [of RA], primary care providers should, therefore, refer the suspected cases of arthritis to the rheumatologist promptly.”