B-096 Are we truly Choosing Wisely? An Assessment of non-specific testing, time to diagnosis and costs related to the diagnosis of Rheumatoid Arthritis

Abstract

Abstract Background Treatment of Rheumatoid Arthritis (RA) early in the disease course can significantly impact patient quality of life by preventing the development of joint erosion and slowing down disease progression. Timely diagnosis is a critical aspect of early treatment. Most patients initially present within a primary care (PC) setting where a variety of non-specific tests/test algorithms are used. We reviewed 8 years’ worth of RA real-world laboratory data to assess time to diagnosis (TTD) between different tests/test combinations. Methods Data extraction spanning 2014–2021 was pulled from a US laboratory, using Rheumatoid Factor (RF) and Anti-Cyclic Citrullinated Peptide (CCP) positivity as the primary inclusion criteria. Additionally, sex, age, ordering physician specialty, ICD-10 codes, test order date and test codes (ESR, CRP, ANA screen, RF isotypes) were pulled longitudinally. Results This data set includes 3024 patients with RA (RA ICD code). Of these, 45% were first suspected and evaluated within PC. TTD between patients initially tested with only CRP or ESR had a median TTD of 920 days and those tested with ANA only had a median TTD of 685 days. Those tested with RF + CCP or RF + CCP + ANA had a median TTD of 367 days and 290 days, respectively. Conclusion Our data set highlights the impact of test methods on TTD of patients with RA, with tests combinations more specific for RA significantly decreasing TTD. Further analysis will be conducted to determine the downstream implications resulting between these diagnostic delays. Standardizing and implementing initial testing algorithms could potentially decrease RA TTD, and directly impact burden of care.