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Year : 2013  |  Volume : 8  |  Issue : 4  |  Page : 161-164

Lag time between disease onset and first visit to a tertiary rheumatology centre by patients with rheumatoid arthritis

Department of Rheumatology, P. D. Hinduja National Hospital and Research Centre, Mumbai 400016, Maharashtra, India

Correspondence Address:
Neena Chitnis
Department of Rheumatology, P. D. Hinduja National Hospital and Research Centre, Mumbai 400016, Maharashtra
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Source of Support: None, Conflict of Interest: None

DOI: 10.1016/j.injr.2013.06.008

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Introduction: Rheumatoid arthritis is a chronic disabling disease. Presently there is great emphasis on early diagnosis and treatment to prevent damage and disability. There is however, lack of awareness of urgency to treat amongst lay persons and doctors resulting in treatment delays. We have studied the delay in referral, disease activity and damage at first presentation to our clinic. Patients: This is a retrospective chart analysis of 357, consecutively seen patients between January 2002 and December 2005. At first visit demographic details, details of prior treat- ment, disease activity, disability index, clinical and radiological damage were noted in a predesigned form. Results: There were 313 females, 44 males. The median age was 50 years and the disease duration was 88 months. The median delay in seeing a rheumatologist was 24 months (1 e372). 278 (78%) had received DMARD with 163 (58%) patients taking regular DMARD treatment. Methotrexate monotherapy was the most common DMARD used: 160 (74%) were on <10 mg per week. 143 (40%) had received or were on steroids, 260 (73%) had taken alternate form of treatment. 257 (72%) had evidence of radiological damage. HAQ (325 patients) was <1 in 159 (49%), 1e2 in 134 (41%), and >2 in 32 (10%). DAS-28 (3) (350 patients) was, <2.4 in 14 (4%), 2.4e3.2 in 21 (6%), 3.2e5.1 in 112 (32%), >5.1 in 203 (58%). Conclusions: There is a long delay in referral to a rheumatologist. Even on treatment, disease is not well controlled. Majority of the patients have high disease activity with significant disability and evidence of joint damage. Special efforts are needed to ensure early insti- tution of therapy with the aim to achieve maximum disease control as early as possible.

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