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Arthritis Rheum. 2010 Dec;62(12):3537-46. doi: 10.1002/art.27692. Long-term impact of delay in assessment of patients with early arthritis. van der Linden MP, le Cessie S, Raza K, van der Woude D, Knevel R, Huizinga TW, van der Helm-van Mil AH. Leiden University Medical Center, Leiden, The Netherlands. M.P.M.van_der_Linden@lumc.nl Abstract OBJECTIVE: During the last decade, rheumatologists have learned to initiate disease-modifying antirheumatic drugs (DMARDs) early to improve the outcome of rheumatoid arthritis (RA). However, the effect of delay in assessment by a rheumatologist on the outcome of RA has scarcely been explored. The purpose of this study was to examine the association between delay in assessment by a rheumatologist, rates of joint destruction, and probability of achieving DMARD-free remission in patients with RA. Patient characteristics associated with components of delay (by the patient, by the general practitioner [GP], and overall) were assessed. METHODS: A total of 1,674 early arthritis patients from the Leiden Early Arthritis Clinic cohort were evaluated for patient delay, GP delay, and total delay in assessment by a rheumatologist. Among 598 RA patients, associations between total delay, achievement of sustained DMARD-free remission, and the rate of joint destruction over 6 years followup were determined. RESULTS: The median patient, GP, and total delays in seeing a rheumatologist among patients with early arthritis were 2.4 weeks, 8.0 weeks, and 13.7 weeks, respectively. Among all diagnoses, those diagnosed as having RA or spondylarthritis had the longest total delay (18 weeks). Among the RA patients, 69% were assessed in ≥12 weeks; this was associated with a hazard ratio of 1.87 for not achieving DMARD-free remission and a 1.3 times higher rate of joint destruction over 6 years, as compared with assessment in <12 weeks. Older age, female sex, gradual symptom onset, involvement of the small joints, lower levels of C-reactive protein, and the presence of autoantibodies were associated with longer total delay. CONCLUSION: Only 31% of the RA patients were assessed in <12 weeks of symptom onset. Assessment in <12 weeks is associated with less joint destruction and a higher chance of achieving DMARD-free remission as compared with a longer delay in assessment. These results imply that attempts to diminish the delay in seeing a rheumatologist will improve disease outcome in patients with RA.
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早期关节炎患者延迟就诊风湿专科的长期影响 Linden MP,et al.Arthritis Rheum. 2010 Dec;62(12):3537-46. 目的：在过去十年中，风湿科医生已开始早期使用DMARDs以改善RA预后。然而，有关延迟就诊风湿专科对RA预后的影响鲜有研究。本文旨在探讨延迟就诊风湿专科与RA关节破坏率、达到不使用DMARD缓解的可能性之间的关联，了解与延迟（患者、全科医生和总体）有关的患者特征。 方法：对Leiden早期关节炎医学中心的1674例早期关节炎患者进行有关患者延迟、全科医生延迟和总体延迟的评估。在598例RA患者中，评估总体延迟与达到不使用DMARD维持缓解、随访超过6年的关节破坏率之间的关联。 结果：在早期关节炎患者中，延迟就诊风湿专科的患者、全科医生和总体延迟平均时间分别为2.4周、8.0周和13.7周。在所有疾病中，诊断为RA或脊柱关节炎的患者总体延迟时间更长（18周）。在RA患者中，69%超过12周就诊，与在12周内就诊的患者相比，其与未达到不使用DMARD缓解的危害比为1.87，6年以上的关节破坏率高出1.3倍。年龄大、女性、症状缓慢出现、小关节受累、CRP低、存在自身抗体与总体延迟时间更长相关。 结论：仅有31%RA患者在出现症状12周内就诊于风湿专科。与延迟时间超过12周相比，12周内就诊与关节破坏更少、达到不使用DMARD缓解的可能性更大相关。这些结果提示缩短延迟就诊风湿专科时间有助于改善RA患者的疾病预后。 |