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

Lookup NU author(s): Dr Arthur Pratt, Dr Dennis Lendrem, Ben Hargreaves, Professor John Isaacs

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This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).


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.


Publication metadata

Author(s): Pratt AG, Lendrem D, Hargreaves B, Aslam O, Galloway JB, Isaacs JD

Publication type: Article

Publication status: Published

Journal: Rheumatology

Year: 2016

Volume: 55

Issue: 10

Pages: 1843-1848

Online publication date: 03/07/2016

Acceptance date: 24/05/2016

Date deposited: 21/12/2016

ISSN (print): 1462-0324

ISSN (electronic): 1462-0332

Publisher: Oxford University Press

URL: http://dx.doi.org/10.1093/rheumatology/kew261

DOI: 10.1093/rheumatology/kew261


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