A quarter of patients time their early rheumatoid arthritis onset differently than physicians

Abstract

ObjectiveEarly rheumatoid arthritis (RA) treatment requires timely recognition. This large, multicentre study compared patient-reported vs physician-reported onset of early RA.MethodsPatients from the Canadian Early ArThritis CoHort with early/suspected RA (persistent synovitis <1 year) completed questionnaires asking about the date of symptom onset; and rheumatologists date of onset for persistent synovitis. Groups with similar reported timing (patient and physician) versus differing timing of 30 days or more were compared.ResultsIn 2683 patients, the median patient symptom duration (IQR) was 178 days (163) and physician-reported duration was 166 (138). 1940 (72%) patients had similar patient-reported and physician-reported onset (<30 days), whereas 497 (18%) reported onset 30 or more days preceding physicians, and 246 (9%) 30 or more days after physicians. Patients reporting onset preceding physicians had lower baseline Disease Activity Score based on 28 joint count, swollen joint counts and erythrocyte sedimentation rate (p<0.05). Patients reporting onset after physicians were more likely to be rheumatoid factor positive (p<0.001) and had higher anticitrullinated protein antibody titres (p<0.009). Regression showed low income, smoking, fibromyalgia, osteoarthritis and baseline non-methotrexate non-biological disease-modifying antirheumatic drug use were predictors for longer patient-reported symptoms. At 12 months, patients reporting longer symptom duration than physicians had lower rates of Simplified Disease Activity Index remission and higher physician global assessments.ConclusionOver one-fourth of patients reported differences of >1 month in symptom onset from their rheumatologist. Patients with longer symptom durations had less improvement at 1 year, which may be reflective of comorbid musculoskeletal conditions.

Earlier is better when treating rheumatoid arthritis: but can we detect a window of opportunity?

“…doi:10.1136/rmdopen-2020-001242 Furthermore, symptom onset was patient reported and may therefore be subject to recall bias, in which the symptom onset may be recalled less precisely if it occurred longer ago. 24 Although we were able to assess the existence of a WOO to achieve sDFR in two independent cohorts for patients starting treatment with fast-acting combination therapy, we could not validate our findings for patients starting treatment with slow-acting csDMARD monotherapy, because all patients in the IMPROVED study started combination therapy with methotrexate and prednisone.…”