OP0037 USE OF PRIMARY HEALTHCARE AND RADIOLOGICAL IMAGING PRECEDING A DIAGNOSIS OF RHEUMATOID ARTHRITIS: A DANISH NATIONWIDE COHORT STUDY

Abstract

BackgroundFocus on early diagnosis and treatment initiation is key in rheumatoid arthritis (RA) to prevent permanent joint damage and systemic manifestations. Increased use of healthcare services before an RA diagnosis can be seen as a proxy for symptom presentation and the actions taken by healthcare professionals, and thus indicate an opportunity for earlier diagnosis. However, little is known about where and when people use healthcare services before an RA diagnosis.ObjectivesTo explore the pattern in use of healthcare services during the 12 months preceding a diagnosis of RA in Denmark.MethodsWe conducted a population-based cohort study using data from Danish national registries. For every patient diagnosed with RA in 2014-2018 we matched ten reference persons from the Danish general population without RA, listed in the same general practice and with same age and sex. Healthcare use was defined as: daytime face to face contacts to general practice, contacts to private practicing physiotherapists.We estimated the monthly healthcare use for patients with RA and reference persons in the 12 months preceding the diagnosis, and we compared their healthcare use by incidence rate ratios (IRR) for each month, adjusted for sociodemographic characteristics and comorbidity.Results7,427 patients with RA and 74,270 reference persons were included in the study. The median age was 62 years (interquartile interval (IQI): 51-71), and 65% were women. Patients with RA had an average of 0.5 contacts per month in general practice from 12 months until six months prior to the diagnosis (Figure 1); this number increased from six months before the diagnosis to an average of one contact in the last month before the diagnosis. Reference persons had an average of 0.4 contacts per months throughout the entire study period. Compared to their references, patients with RA had statistically significantly more contacts during all 12 months before the diagnosis date; IRR increased from 1.25 (95% CI: 1.19-1.30) to 2.63 (2.55-2.71) during the study period.Patients with RA also had statstistically significantly more contacts to physiotherapists compared to their references throughout the entire study period, and increasing contact rates from eight months before the diagnosis. This was primarily driven by more contacts in women with RA compared to their references.ConclusionPatients with RA had more contacts to general practice and physiotherapists in all 12 months preceding the RA diagnosis compared to references and these contact rates increased further the last six to eight months in patients with RA. This indicates symptom presentation for several months before the RA is diagnosed, and it indicates that a window of opportunity exists to expedite referral to specialist care and the diagnosis of RA.Disclosure of InterestsNone declared.