Sørensen Jan, Hetland Merete Lund
Centre for Applied Health Services Research, University of Southern Denmark, Odense, Denmark.
DANBIO registry, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Glostrup Hospital, Glostrup, Denmark Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
Ann Rheum Dis. 2015 Mar;74(3):e12. doi: 10.1136/annrheumdis-2013-204867. Epub 2014 Feb 17.
BACKGROUND/PURPOSE: Early diagnosis of inflammatory rheumatic diseases is important in order to improve long-term outcome. We studied whether delay in diagnosis (time between onset of symptoms and establishment of diagnosis) in patients with rheumatoid arthritis (RA), psoriatic arthritis (PSA) and ankylosing spondylitis (AS) changed from year 2000 to 2011.
Month and year of initial symptoms and diagnosis, gender, hospital, year of birth and date of first data entry were obtained for 13,721 patients with RA, PSA or AS who had been registered in the DANBIO registry. Time between symptom onset and diagnosis was modelled using generalised linear regression to predict the average duration for each calendar year of initial symptoms with adjustments for gender, year of birth and date of DANBIO entry.
Patients with valid data (RA: 10,416 (73%); PSA: 1970 (68%); AS: 1335 (65%)) did not differ significantly from the whole DANBIO population, except more missing data in early years. The regression model showed that the mean duration from initial symptoms to diagnosis for RA, PSA and AS declined steadily from 30, 53 and 66 months (year 2000), respectively, to 3-4 months (year 2011). Sensitivity analyses including patients who were included after 2005, patients who had received biological treatment or had symptom onset less than 2 and 5 years prior to first entry into DANBIO showed similar results.
Since the year 2000, a significant reduction in diagnostic delay was observed in this large cohort of patients with RA, PSA or AS, probably reflecting a stronger awareness of the importance of early diagnosis.
背景/目的：为改善炎性风湿性疾病的长期预后，早期诊断至关重要。我们研究了类风湿关节炎（RA）、银屑病关节炎（PSA）和强直性脊柱炎（AS）患者的诊断延迟情况（症状出现至确诊的时间间隔）在2000年至2011年期间是否发生了变化。
从丹麦生物制剂登记处登记的13721例RA、PSA或AS患者中获取初始症状和诊断的月份及年份、性别、医院、出生年份和首次录入数据的日期。使用广义线性回归对症状出现至诊断的时间进行建模，以预测每个初始症状日历年份的平均持续时间，并对性别、出生年份和丹麦生物制剂登记处录入日期进行调整。
有有效数据的患者（RA：10416例（73%）；PSA：1970例（68%）；AS：1335例（65%））与整个丹麦生物制剂登记处人群相比无显著差异，只是早期缺失数据较多。回归模型显示，RA、PSA和AS从初始症状到诊断的平均持续时间分别从2000年的30、53和66个月稳步下降至2011年的3 - 4个月。敏感性分析纳入2005年后纳入的患者、接受过生物治疗的患者或首次进入丹麦生物制剂登记处前症状出现少于2年和5年的患者，结果相似。
自2000年以来，在这一大型RA、PSA或AS患者队列中观察到诊断延迟显著减少，这可能反映出对早期诊断重要性的认识增强。
