Rheumatoid arthritis (RA) is a chronic, progressive systemic immune-mediated inflammatory disease of the connective tissue engaging mainly the peripheral joints. Its course is mainly as a symmetric erosive polyarthritis. In patients with persisting inflammation due to delay of diagnosis or due to inadequate therapy behaviour, the probability of disability is increased, the cardiovascular risk is increased, and the survival rate is reduced. There is more than enough scientific evidence that the earlier the patients with RA are diagnosed and treated, the better their prognosis is. There is a growing number of medicines, including biological ones, that are relatively safe and highly efficient in the control of synovial inflammation, especially when therapy with them is started early. Irrespective of this, the studies analysing the time from the onset of the symptoms until the start of the disease modifying anti-rheumatic drug (DMARD) therapy show that there are significant delays that vary from 6 to 57 months, depending on the geographic region. The review examines the main reasons for the diagnostic delay and the consequences from it. The emphasis is on the role of the GP in the strategy for early diagnosis of RA. The suggested recommendation for early referral is an instrument of the doctors in the outpatient care to identify the potential patients with an active RA at the beginning of the disease. The early referral to a rheumatologist for a final diagnosis and early treatment with DMARD should improve the long-term outcome of RA.
Христова Св., Димитров Св., Русева Ж., Герова Д., Стефанов Я., Маджова В., Кадинов Вл., Оценка на факторите за клинично протичане е ефекта от лечението на болни с ревматоиден артрит, Сп. Обща медицина, 2019г., бр.3, стр. 59.
Raza K, Stack R, Kumar K, et al. Delays in assessment of patients with rheumatoid arthritis: variations across Europe. Ann Rheum Dis. 2011;70:1822–1825. [PubMed] [Google Scholar];
Kumar K, Daley E, Carruthers DM, et al. Delay in presentation to primary care physicians is the main reason why patients with rheumatoid arthritis are seen late by rheumatologists. Rheumatology (Oxford) 2007;46:1438–1440. [PubMed] [Google Scholar];
Pratt AG, Lendrem D, Hargreaves B, Aslam O, Galloway JB, Isaacs JD. Components of treatment delay in rheumatoid arthritis differ according to autoantibody status: validation of a single-centre observation using national audit data. Rheumatology (Oxford) 2016;55:1843–1848.
S Irvine, R Munro, D Porter, Early referral, diagnosis, and treatment of rheumatoid arthritis: evidence for changing medical practice, Annals of the Rheumatic Diseases;
Rosa, Javier E. MD, MSc; García, María Victoria MD; Luissi, Aurelia MD; Pierini, Florencia MD; Sabelli, Mirtha MD; Mollerach, Florencia MD; Soriano, Enrique R. MD, MSc JCR:Delay in Diagnosis and Treatment Journal of Clinical Rheumatology: October 2020 - Volume 26 - Issue 7S - p S148-S152;
Karim Raza, Rebecca Stack, Kanta Kumar, Andrew Filer, Jacqueline Detert, Hans Bastian, Gerd R Burmester, Prodromos Sidiropoulos, Eleni Kteniadaki, Argyro Repa, Tore Saxne, Carl Turesson, Herman Mann, Jiri Vencovsky, Anca Catrina, Aikaterini Chatzidionysiou, Aase Hensvold, Solbritt Rantapää-Dahlqvist, Alexa Binder, Klaus Machold, Brygida Kwiakowska, Adrian Ciurea, Giorgio Tamborrini, Diego Kyburz, Christopher D Buckley, Clinical and epidemiological research, Concise report, Delays in assessment of patients with rheumatoid arthritis: variations across Europe
P Emery, F C Breedveld, M Dougados, J R Kalden, M H Schiff, J S Smolen Early referral recommendation for newly diagnosed rheumatoid arthritis: evidence based development of a clinical guide, Ann Rheum Dis 2002;61:290–297
K. Kumar, E. Daley, D. M. Carruthers, D. Situnayake, C. Gordon, K. Grindulis, C. D. Buckley, F. Khattak, K. Raza, Delay in presentation to primary care physicians is the main reason why patients with rheumatoid arthritis are seen late by rheumatologists, Rheumatology, Volume 46, Issue 9, September 2007, Pages 1438–1440, https://doi.org/10.1093/rheumatology/kem130 Published:18 June 2007
Irvine S, Munro R, Porter D. Early referral, diagnosis, and treatment of rheumatoid arthritis: evidence for changing medical practice, Ann Rheum Dis, 1999, vol. 58(pg. 510-3)
K. Kumar, E. Daley, D. M. Carruthers, D. Situnayake, C. Gordon, K. Grindulis, C. D. Buckley, F. Khattak, K. RazaDelay in presentation to primary care physicians is the main reason why patients with rheumatoid arthritis are seen late by rheumatologists Rheumatology, Volume 46, Issue 9, September 2007, Pages 1438–1440, https://doi.org/10.1093/rheumatology/kem130 Published:18 June 2007
Palm O, Purinszky E. Women with early rheumatoid arthritis are referred later than men, Ann Rheum Dis, 2005, vol. 64 (pg. 1227-8)
Rosa, Javier E. MD, MSc; García, María Victoria MD; Luissi, Aurelia MD; Pierini, Florencia MD; Sabelli, Mirtha MD; Mollerach, Florencia MD; Soriano, Enrique R. MD, MSc, JCR: Journal of Clinical Rheumatology: October 2020 - Volume 26 - Issue 7S - p S148-S152
Raza K, Stack R, Kumar K, et al. Delays in assessment of patients with rheumatoid arthritis: variations across Europe. Ann Rheum Dis. 2011;70:1822–1825.
Lacaille D, Anis AH, Guh DP, et al. Gaps in care for rheumatoid arthritis: a population study. Arthritis Rheum. 2005;53:241–248.
Ward MM, Leigh JP, Fries JF. Progression of functional disability in patients with rheumatoid arthritis. Associations with rheumatology subspecialty care. Arch Intern Med. 1993;153:2229–2237.
Aletaha D, Nell VP, Stamm T, et al. Acute phase reactants add little to composite disease activity indices for rheumatoid arthritis: validation of a clinical activity score. Arthritis Res Ther. 2005;7:R796–R806.
Raza K, Stack R, Kumar K, et al. Delays in assessment of patients with rheumatoid arthritis: variations across Europe. Ann Rheum Dis. 2011;70:1822–1825
Hussain W, Noorwali A, Janoudi N, et al. From symptoms to diagnosis: an observational study of the journey of rheumatoid arthritis patients in Saudi Arabia. Oman Med J. 2016;31:29–34.
Marcos J, Waimann C, Dal Pra F, et al. General characteristics of an early arthritis cohort in Argentina. Rheumatology (Oxford). 2011;50:110–116.
Palleiro D. Diagnostic delay in rheumatoid arthritis. J Clin Rheumatol. 2006;12(Supl):41.
Rodríguez-Polanco E, Al Snih S, Kuo YF, et al. Lag time between onset of symptoms and diagnosis in Venezuelan patients with rheumatoid arthritis. Rheumatol Int. 2011;31:657–665.
Jamal S, Alibhai SM, Badley EM, et al. Time to treatment for new patients with rheumatoid arthritis in a major metropolitan city. J Rheumatol. 2011;38:1282–1288.
Soo-Kyoung Cho,1,2 Dam Kim,1,2 Soyoung Won,2 Jiyoung Lee,2 Chan-Bum Choi,1,2 Jung-Yoon Choe,3Seung-Jae Hong,4 Jae-Bum Jun,1 Tae-Hwan Kim,1 Eunmi Koh,5 Hye-Soon Lee,6 Jisoo Lee,7 Dae-Hyun Yoo,1Bo Young Yoon,8 Sang-Cheol Bae,1,2 Yoon-Kyoung Sung,1,2 and Korean Observational Study Network for Arthriti Factors associated with time to diagnosis from symptom onset in patients with early rheumatoid arthritis, 2017 Dec 15. doi: 10.3904/kjim.2017.113
