Departments of Medicine and Community Health Sciences, University of Calgary, 3330 Hospital Dr NW, Calgary, AB, T2N 4N1, Canada,
Rheumatol Int. 2014 Jan;34(1):85-92. doi: 10.1007/s00296-013-2846-5. Epub 2013 Aug 30.
Early diagnosis and treatment yield optimal outcomes in rheumatoid arthritis (RA); thus, barriers to disease recognition must be identified and addressed. We determined the impact of sociodemographic factors, medical comorbidities, family history, and disease severity at onset on the time to diagnosis in early RA. The Canadian early ArThritis CoHort study data on 1,142 early RA patients were analyzed for predictors of time to diagnosis using regression analysis. Sociodemographic factors (age, sex, income strata, education, ethnicity), measures of disease activity (joint counts, DAS28 score, acute-phase reactants, patient global evaluation, function), family history, serology, chronic musculoskeletal and mental health conditions, and obesity at diagnosis were considered. In multivariate linear regression analysis, more swollen joints (β = -0.047 per joint, 95 % CI -0.085, -0.010, p = 0.014), higher erythrocyte sedimentation rate (ESR) (β = -0.012 per 1 mm/h, 95 % CI -0.022, -0.002, p = 0.0018), and worse patient global scores (β = -0.082 per 1 unit on a visual analogue scale, 95 % CI -0.158, -0.006, p = 0.034) at baseline predicted a shorter time to diagnosis. Anti-cyclic citrullinated peptide (anti-CCP) antibody positivity (β = 0.688, 95 % CI 0.261, 1.115, p = 0.002) and low income (annual <$20,000 β = 1.185, 95 % CI 0.227, 2.143, p = 0.015; annual $20,000-50,000 β = 0.933, 95 % CI 0.069, 1.798, p = 0.034) increased time to diagnosis. In the logistic regression models, the odds of being diagnosed within 6 months of symptom onset were increased for each swollen joint present [odds ratio (OR) 1.04, 95 % CI 1.02-1.06 per joint], each 1 mm/h elevation in the ESR (OR 1.01, 95 % CI 1.00-1.02), and decreased for patients who were either rheumatoid factor or anti-CCP positive compared to both factors being negative (OR 0.68, 95 % CI 0.51-0.91). Higher disease activity results in a more rapid diagnosis for Canadian patients with early RA, but those with lower income have delays in diagnosis. Strategies to identify patients with a less severe disease presentation and in lower socioeconomic strata are needed to ensure equal opportunity for optimal management.
早期诊断和治疗可使类风湿关节炎（RA）获得最佳疗效；因此，必须识别和解决疾病认知的障碍。我们确定了社会人口统计学因素、合并症、家族史和发病时疾病严重程度对早期 RA 诊断时间的影响。使用回归分析对加拿大早期关节炎队列研究的 1142 例早期 RA 患者的数据进行了分析，以确定诊断时间的预测因素。考虑了社会人口统计学因素（年龄、性别、收入阶层、教育、种族）、疾病活动度测量（关节计数、DAS28 评分、急性期反应物、患者整体评估、功能）、家族史、血清学、慢性肌肉骨骼和心理健康状况以及诊断时的肥胖。在多元线性回归分析中，更多的肿胀关节（每关节增加 0.047 个，95%CI-0.085，-0.010，p=0.014）、更高的红细胞沉降率（ESR）（每增加 1 毫米/小时增加 0.012 个，95%CI-0.022，-0.002，p=0.0018）和更差的患者整体评分（每增加 1 个单位的视觉模拟量表增加 0.082 个，95%CI-0.158，-0.006，p=0.034）在基线时预测诊断时间更短。抗环瓜氨酸肽（抗-CCP）抗体阳性（β=0.688，95%CI 0.261，1.115，p=0.002）和低收入（年收入<20,000 美元β=1.185，95%CI 0.227，2.143，p=0.015；年收入 20,000-50,000 美元β=0.933，95%CI 0.069，1.798，p=0.034）增加了诊断时间。在逻辑回归模型中，与两种因子均为阴性相比，每出现一个肿胀关节，发病后 6 个月内被诊断的可能性就会增加[优势比（OR）1.04，95%CI 1.02-1.06/关节]，ESR 每升高 1 毫米/小时（OR 1.01，95%CI 1.00-1.02），患病的可能性就会增加。与两种因子均为阴性相比，类风湿因子或抗-CCP 阳性的患者的诊断时间更短（OR 0.68，95%CI 0.51-0.91）。加拿大早期 RA 患者疾病活动度越高，诊断速度越快，但收入较低的患者诊断时间延迟。需要制定策略来识别疾病表现较轻和社会经济地位较低的患者，以确保有平等的机会获得最佳管理。
