Chan K W, Felson D T, Yood R A, Walker A M
Harvard School of Public Health, Boston, Massachusetts.
Arthritis Rheum. 1994 Jun;37(6):814-20. doi: 10.1002/art.1780370606.
Rheumatoid arthritis (RA) may be biologically reversible if treated in the first several months, yet it is unknown whether patients are diagnosed that early. We investigated the lag time between symptom onset and diagnosis of RA in a population with excellent access to rheumatology care.
Using review of medical records, we evaluated all patients newly diagnosed as having RA from 1987 through 1990, at a health maintenance organization in central Massachusetts. Total lag time from symptom onset to first definite diagnosis was divided into medical encounter lag time (from symptom onset to first medical encounter) and diagnosis lag time (from first medical encounter to diagnosis).
The median total lag time was 36 weeks (range 4 weeks to > 10 years). The median medical encounter lag time was 4 weeks (not all patients included in the analysis). The median diagnosis lag time was 18 weeks. Diagnosis lag time was shorter for patients with progressive disease and positive rheumatoid factor on the initial test. Of 25 patients with symmetric arthritis and positive rheumatoid factor, only 5 (20%) were diagnosed within 2 months, and 10 (40%) were diagnosed more than 6 months after symptom onset.
RA diagnosis is usually delayed for several months after symptoms begin, in large part because of delay in diagnosis by the physician. Thus, the goal of initiating treatment extremely early may be unrealistic for most patients.
类风湿关节炎（RA）若在发病的最初几个月内进行治疗，可能在生物学上是可逆的，但尚不清楚患者能否被如此早期诊断。我们调查了在一个极易获得风湿病治疗服务的人群中，从症状出现到RA确诊的延迟时间。
通过查阅病历，我们评估了1987年至1990年期间在马萨诸塞州中部一家健康维护组织中新诊断为RA的所有患者。从症状出现到首次明确诊断的总延迟时间分为就医延迟时间（从症状出现到首次就医）和诊断延迟时间（从首次就医到诊断）。
总延迟时间的中位数为36周（范围为4周至>10年）。就医延迟时间的中位数为4周（分析中并非纳入了所有患者）。诊断延迟时间的中位数为18周。对于病情进展型且初次检查类风湿因子呈阳性的患者，诊断延迟时间较短。在25例对称性关节炎且类风湿因子呈阳性的患者中，只有5例（20%）在2个月内被诊断出来，10例（40%）在症状出现后6个月以上才被诊断。
RA的诊断通常在症状出现后延迟数月，很大程度上是因为医生诊断延迟。因此，对大多数患者来说，极早期开始治疗的目标可能不现实。
