For patients with rheumatoid arthritis (RA), a shorter time to assessment by a rheumatologist is associated with longer disease-modifying antirheumatic drug (DMARD)-free remission times and less joint destruction. However, patients with early arthritis who have a diagnosis of RA experience one of the longest delays and only one-third are assessed within the “window of opportunity.”
van der Linden and associates evaluated patient, general practitioner (GP), and rheumatologist delay in 1674 patients with early arthritis; 598 had RA. The latter patients were evaluated for the relationships among total delay, achievement of DMARD-free remission, and rate of joint destruction over 6 years.
Among patients with early arthritis, the average patient, GP, and rheumatologist delays were 2.4, 8.0, and 13.7 weeks, respectively. Among persons with RA, the delay was longest at 18 weeks; most (67%) of these patients were seen 12 weeks or longer after receiving the diagnosis, and they had a hazard ratio of 1.87 for failure to achieve DMARD-free remission. They also had 1.3 times more joint destruction over 6 years than persons seen before 12 weeks.
The authors noted that diminishing the delay in assessment by a rheumatologist will be crucial to further improvement in disease outcomes.