Delay in presentation of patients with rheumatoid arthritis for specialty care

Abstract

Introduction:Early diagnosis and intervention is known to improve the outcomes in patients with rheumatoid arthritis. Information on the time duration from the symptom onset of rheumatoid arthritis to the presentation to specialty care in Sri Lanka is not available. The aim of this study was to evaluate the time duration from symptom onset to the first visit of patients to a rheumatology specialty clinic in Sri Lanka and changing trends over a period.Methods: This retrospective observational study was carried out in the rheumatology and rehabilitation clinic at the National Hospital of Sri Lanka. Data were collected through an interviewer-administered questionnaire from 60 consecutive consenting patients with rheumatoid arthritis attending the clinic over a period of one month. Further information was added or clarified by perusing clinic records. Data was analyzed using SPSS software version 17.0 and Microsoft Excel 2010.Results: Sixty patients were recruited to the study. Their mean age was 54.23 years (range 19-76 years) and 58 were women. Among them, 38 patients were positive for either rheumatoid factor or anti-cyclic citrullinated peptide and were considered as seropositive. The average time duration from symptom onset to the first visit to the rheumatology clinic was 15.86 months (SD=18.38). The analysis of trends over 13 years showed an improving trend with gradually shortening time duration. There was no statistically significant difference in the time lag of the first visit to the rheumatology clinic between seronegative and sero-positive groups (p=0.976. CI 95%). Conclusion:There was a significant delay in presentation of patients with rheumatoid arthritis to specialty care, with a trend of gradual improvement over recent years. For optimum treatment outcome, referral of suspected cases to specialty care within 6 weeks of presentation to the first medical contact is recommended. We found that there is a significant delay in referral system that needs remedying to meet the standard recommendations.