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Rheumatology (Oxford). 2016 Oct;55(10):1843-8. doi: 10.1093/rheumatology/kew261. Epub 2016 Jul 3.

Components of treatment delay in rheumatoid arthritis differ according to autoantibody status: validation of a single-centre observation using national audit data.

Author information

1
National Institute for Health Research Newcastle Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust and Newcastle University, Newcastle upon Tyne arthur.pratt@ncl.ac.uk.
2
National Institute for Health Research Newcastle Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust and Newcastle University, Newcastle upon Tyne.
3
Academic Department of Rheumatology, King's College London, King's College London School of Medicine, Weston Education Centre, London, UK.

Abstract

OBJECTIVE:

To determine whether time to treatment following symptom onset differs between RA patients according to autoantibody status.

METHODS:

A single-centre retrospective analysis of a UK early RA inception cohort was first undertaken to identify those components of the patient journey that differed by serological subtype. Data from a UK national audit of early inflammatory arthritis patients was accessed to replicate the key finding.

RESULTS:

A total of 173 RA patients were diagnosed over a 31-month period, of whom 80 (46%) were ACPA/RF double-seropositive (ACPA(+)/RF(+)), 53 (31%) ACPA(-)/RF(-), 17 (10%) ACPA(+)/RF(-) and 23 (13%) RF(+)/ACPA(-) Overall, ACPA(+)/RF(+) patients experienced significantly longer symptom duration before DMARD initiation. This was accounted for by delays in their presentation to primary care following symptom onset-a finding that was robustly confirmed in an independent dataset of 2192 UK early RA patients. In contrast, ACPA(-)/RF(-) patients were significantly more likely to experience delays in DMARD initiation after presenting to secondary care.

CONCLUSION:

Causes of treatment delays in early RA differ according to patients' autoantibody status. More insidious symptom onset and/or distinct health-seeking behaviours among ACPA(+)/RF(+) patients may contribute to late presentations in primary care, whereas ACPA(-)/RF(-) patients experience delayed diagnosis and treatment in secondary care. These observations inform the research agenda, potentially influencing the design of service delivery for early arthritis patients.

KEYWORDS:

anti-citrullinated peptide; auto-antibodies; rheumatoid arthritis; rheumatoid factor

PMID:
27373893
PMCID:
PMC5034219
DOI:
10.1093/rheumatology/kew261
[Indexed for MEDLINE]
Free PMC Article

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