McMaster University, Hamilton, ON, Canada.
J Rheumatol. 2012 Nov;39(11):2088-97. doi: 10.3899/jrheum.120100. Epub 2012 Aug 15.
To determine the proportion of patients with rheumatoid arthritis (RA) under rheumatologic care treated with disease-modifying antirheumatic drugs (DMARD) within 6 months from symptom onset and the components of time to treatment and its predictors.
A historical inception cohort of 339 patients with RA randomly selected from 18 rheumatology practices was audited. The proportion that initiated DMARD treatment within 6 months from symptom onset was estimated using Kaplan-Meier analysis. Time to each component of the care pathway was estimated. Multivariable modeling was used to determine predictors of early treatment using 12 preselected variables available in the clinical charts. Bootstrapping was used to validate the model.
Within 6 months from symptom onset, 41% (95% CI 36%-46%) of patients were treated with DMARD. The median time to treatment was 8.4 (interquartile range 3.8-24) months. Events preceding rheumatology referral accounted for 78.1% of the time to treatment. The most prominent predictor of increased time to treatment was a concomitant musculoskeletal condition, such as osteoarthritis or fibromyalgia. The significance of other variables was less consistent across the models investigated. Included variables accounted for 0.69 ± 0.03 of the variability in the model.
Fewer than 50% of patients with RA are treated with DMARD within 6 months from symptom onset. Time to referral to rheumatology represents the greatest component delay to treatment. Concomitant musculoskeletal condition was the most prominent predictor of delayed initiation of DMARD. Implications of these and other findings warrant further investigation.
确定在症状出现后 6 个月内接受风湿科治疗的类风湿关节炎（RA）患者中，使用疾病修饰抗风湿药物（DMARD）治疗的比例，以及治疗时间及其预测因素的组成部分。
从 18 个风湿病诊所中随机抽取了 339 名 RA 患者的历史起始队列进行审核。使用 Kaplan-Meier 分析估计从症状出现到开始 DMARD 治疗的比例。估计了治疗路径的各个组成部分的时间。使用多变量建模，使用临床图表中可用的 12 个预选变量来确定早期治疗的预测因素。使用引导法验证模型。
在症状出现后 6 个月内，41%（95%CI 36%-46%）的患者接受了 DMARD 治疗。治疗的中位数时间为 8.4（四分位距 3.8-24）个月。风湿科转介前的事件占治疗时间的 78.1%。增加治疗时间的最显著预测因素是同时存在肌肉骨骼疾病，如骨关节炎或纤维肌痛。其他变量的意义在不同的模型中不太一致。纳入的变量占模型中变异性的 0.69±0.03。
不到 50%的 RA 患者在症状出现后 6 个月内接受 DMARD 治疗。向风湿病医生转介的时间是治疗延迟的最大组成部分。同时存在的肌肉骨骼疾病是延迟开始 DMARD 的最显著预测因素。这些发现和其他发现的意义需要进一步研究。
