The specific features of diagnosis of rheumatoid arthritis in real clinical practice

Abstract

Objective. To study the specific features of rheumatoid arthritis (RA) in real practice. Subjects and methods. The study included 1810 patients with RA (including 1520 women) whose mean age was 54 years. The history of the disease averaged 7 years. The extensive and late clinical stages of RA were predominant (86% as a whole); 64.6% of the patients were found to have a high inflammatory disease activity (DAS 28 >5.1). Results. The mean interval between the emergence of the first symptoms of RA and the moment of this diagnosis was 24 [8; 44] months. The diagnosis of RA was shown to be established in only 18% of the patients in the first 6 months of the disease onset. However, this indicator increased up to 68% if the patient immediately visited a rheumatologist, by disregarding medical advice from other physicians. Every eight (13%) RA patients aged 55 years require endoprosthetic joint replacement 13 years after the disease onset. These patients had a higher inflammatory process activity (DAS 28 = 6.0) at the moment of the study; their mean methotrexate dose was not greater than 10 mg/week and the interval between the disease onset and the moment of diagnosis was significantly longer that that in the general sample of patients with RA and averaged 31 months. Conclusion. Inadequate training of physicians in rheumatology problems increases the interval between the disease onset and the moment of outpatient diagnosis results in early disability and makes it necessary to make endoprosthetic replacement of large joints in patients with RA.