Diagnosis delay in Egyptian rheumatoid-arthritis patients: underlying factors and outcomes – retrospective observational study

Abstract

Background. Early initiation of rheumatoid arthritis (RA) treatment leads to better outcomes and low disease activity. In spite of these, there is a significant delay between symptom onset and the initiation of therapy. Objective. This study aimed to investigate this diagnostic delay and to analyze its associated factors and outcomes. Patients and method. This cross-sectional study included 167 RA patients fulfilling the 2010 American College of Rheumatology/European League against Rheumatism (ACR/EULAR) classification criteria. All patients were subjected to full clinical, laboratory and radiological assessment and treatment was also received; Disease Activity Score (DAS-28) functional disability evaluation using Modified Health Assessment Questionnaire (MHAQ) MHAQ were reported. Diagnostic delay was assessed regarding duration, associated factors and outcomes. Furthermore, RA patients were divided into early and late diagnosis group with a cutoff of one year and were compared regarding different disease parameters. Results. The median (IQR) lag in diagnosis of RA patients was 12 months (4 24), MHAQ score was significantly positively correlated with delay in diagnosis (p = 0.02). Early diagnosis group patients were statistically significant urban residents (p = 0.01), employed (p = 0.02), with higher educational level (p = 0.02), lower functional index MHAQ (p = 0.02), and were significantly visiting rheumatology specialists early in the disease compared to the late diagnosis group (p =<0.0001). Conclusion. Early diagnosis is still suboptimal. Unemployment, specialist visits other than rheumatology, female gender, rural residence, and lower educational level were associated with the delay in diagnosis in RA patients. Patients with delayed diagnosis showed worse functional disability index.