Naeem Faiza, Khan Saira Elaine Anwer, Saeed Muhammad Ahmed, Farman Sumaira
Faiza Naeem, FCPS Internal Medicine, Rheumatology Fellow, Division of Rheumatology, Fatima Memorial Hospital College of Medicine & Dentistry (FMH), Lahore, Pakistan.
Saira E.A Khan, MRCP (UK), SCE Rheumatology (UK) Assistant Professor, Division of Rheumatology, Fatima Memorial Hospital College of Medicine & Dentistry (FMH), Lahore, Pakistan.
Pak J Med Sci. 2021 Jul-Aug;37(4):1001-1007. doi: 10.12669/pjms.37.4.3471.
To identify factors causing diagnostic and therapeutic delay in patients with rheumatoid arthritis, and to evaluate relationship of diagnostic and therapeutic delay with disease outcome.
This cross-sectional study was conducted in Rheumatology Department, Fatima Memorial Hospital, Lahore, Pakistan, from May 2018 to July 2018. In this study 102 patients fulfilling ACR/EULAR criteria 2010 were enrolled. Lag times were calculated in months: lag-1 (delay in initial medical consultation); lag-2 (delay in consulting rheumatologists); lag-3 (diagnostic delay); lag-4 (therapeutic delay). Disease activity and functional outcome were measured by DAS28, HAQ-DI respectively. Association of lag-3 and lag-4 with HAQ-DI and DAS28 was calculated by Pearson correlation.
Median (IQR) disease duration of study group was 6(2-10) years. Initial consultations were with; orthopedic surgeon 40(39.2%), general practitioner 27(26.5%), rheumatologist 13(12.7%), medical specialists 14(13.7%). Median (IQR) lag times in months: lag-1 (delayed initial consultation): 2(0-5), lag-2 (delay in consulting rheumatologist): 30(7.7-72), lag-3 (diagnostic delay): 12(3-48), lag-4 (therapeutic delay):18(5.7-72). Factors attributed to lag-3 (diagnostic delay) and lag-4 (therapeutic delay) (p<0.05): older Age (r= 0.2), education level(r= - 0.2), initial consultation (non-rheumatologist) (r=0.2), lag-2(r=0.8), >three doctors visited before diagnosis(r=0.6). Positive anti-CCP antibodies(r=0.2) and lag-1 (delayed initial consultation) (r=1) were associated with lag-3 (diagnostic delay) only; no association was found with positive RA factor. Significant correlation (p=<0.05) of lag-3 (diagnostic delay) was found with both DAS28(r=0.2) & HAQ-DI(r=0.2). Similarly lag-4 (therapeutic delay) also correlated with both & DAS28(r=0.2) & HAQ-DI(r=0.3) (p=<0.05).
Diagnostic and therapeutic delay were associated with older age, lower education and delayed consultation with rheumatologist but not with positive RA factor. Positive anti-CCP antibodies were associated with diagnostic delay only. Diagnostic and therapeutic delay led to high disease activity and poor functional outcome in RA patients.
确定导致类风湿关节炎患者诊断和治疗延迟的因素，并评估诊断和治疗延迟与疾病结局的关系。
这项横断面研究于2018年5月至2018年7月在巴基斯坦拉合尔法蒂玛纪念医院风湿科进行。本研究纳入了102例符合2010年美国风湿病学会/欧洲抗风湿病联盟（ACR/EULAR）标准的患者。延迟时间以月计算：延迟-1（初次就医延迟）；延迟-2（咨询风湿病学家延迟）；延迟-3（诊断延迟）；延迟-4（治疗延迟）。分别通过28个关节疾病活动评分（DAS28）、健康评估问卷残疾指数（HAQ-DI）来测量疾病活动度和功能结局。通过Pearson相关性分析计算延迟-3和延迟-4与HAQ-DI和DAS28之间的关联。
研究组的疾病持续时间中位数（四分位间距）为6（2 - 10）年。初次就诊的医生为：骨科医生40例（39.2%）、全科医生27例（26.5%）、风湿病学家13例（12.7%）、内科专家14例（13.7%）。延迟时间中位数（四分位间距）（以月计）：延迟-1（初次就医延迟）：2（0 - 5），延迟-2（咨询风湿病学家延迟）：30（7.7 - 72），延迟-3（诊断延迟）：12（3 - 48），延迟-4（治疗延迟）：18（5.7 - 72）。归因于延迟-3（诊断延迟）和延迟-4（治疗延迟）的因素（p<0.05）：年龄较大（r = 0.2）、教育水平（r = - 0.2）、初次就诊（非风湿病学家）（r = 0.2）、延迟-2（r = 0.8）、诊断前就诊医生>3名（r = 0.6）。抗环瓜氨酸肽（CCP）抗体阳性（r = 0.2）和延迟-1（初次就医延迟）（r = 1）仅与延迟-3（诊断延迟）相关；未发现与类风湿因子阳性有关联。发现延迟-3（诊断延迟）与DAS28（r = 0.2）和HAQ-DI（r = 0.2）均存在显著相关性（p =<0.05）。同样，延迟-4（治疗延迟）也与DAS28（r = 0.2）和HAQ-DI（r = 0.3）相关（p =<0.05）。
诊断和治疗延迟与年龄较大、教育程度较低以及咨询风湿病学家延迟有关，但与类风湿因子阳性无关。抗CCP抗体阳性仅与诊断延迟有关。诊断和治疗延迟导致类风湿关节炎患者疾病活动度高且功能结局差。
