Cargando…

Components of treatment delay in rheumatoid arthritis differ according to autoantibody status: validation of a single-centre observation using national audit data

Objective. To determine whether time to treatment following symptom onset differs between RA patients according to autoantibody status. Methods. A single-centre retrospective analysis of a UK early RA inception cohort was first undertaken to identify those components of the patient journey that diff...

Descripción completa

Detalles Bibliográficos
Autores principales: Pratt, Arthur G., Lendrem, Dennis, Hargreaves, Ben, Aslam, Osman, Galloway, James B., Isaacs, John D.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5034219/
https://www.ncbi.nlm.nih.gov/pubmed/27373893
http://dx.doi.org/10.1093/rheumatology/kew261
_version_ 1782455227117469696
author Pratt, Arthur G.
Lendrem, Dennis
Hargreaves, Ben
Aslam, Osman
Galloway, James B.
Isaacs, John D.
author_facet Pratt, Arthur G.
Lendrem, Dennis
Hargreaves, Ben
Aslam, Osman
Galloway, James B.
Isaacs, John D.
author_sort Pratt, Arthur G.
collection PubMed
description Objective. To determine whether time to treatment following symptom onset differs between RA patients according to autoantibody status. Methods. A single-centre retrospective analysis of a UK early RA inception cohort was first undertaken to identify those components of the patient journey that differed by serological subtype. Data from a UK national audit of early inflammatory arthritis patients was accessed to replicate the key finding. Results. A total of 173 RA patients were diagnosed over a 31-month period, of whom 80 (46%) were ACPA/RF double-seropositive (ACPA(+)/RF(+)), 53 (31%) ACPA(−)/RF(−), 17 (10%) ACPA(+)/RF(−) and 23 (13%) RF(+)/ACPA(−). Overall, ACPA(+)/RF(+) patients experienced significantly longer symptom duration before DMARD initiation. This was accounted for by delays in their presentation to primary care following symptom onset—a finding that was robustly confirmed in an independent dataset of 2192 UK early RA patients. In contrast, ACPA(−)/RF(−) patients were significantly more likely to experience delays in DMARD initiation after presenting to secondary care. Conclusion. Causes of treatment delays in early RA differ according to patients’ autoantibody status. More insidious symptom onset and/or distinct health-seeking behaviours among ACPA(+)/RF(+) patients may contribute to late presentations in primary care, whereas ACPA(−)/RF(−) patients experience delayed diagnosis and treatment in secondary care. These observations inform the research agenda, potentially influencing the design of service delivery for early arthritis patients.
format Online
Article
Text
id pubmed-5034219
institution National Center for Biotechnology Information
language English
publishDate 2016
publisher Oxford University Press
record_format MEDLINE/PubMed
spelling pubmed-50342192016-09-26 Components of treatment delay in rheumatoid arthritis differ according to autoantibody status: validation of a single-centre observation using national audit data Pratt, Arthur G. Lendrem, Dennis Hargreaves, Ben Aslam, Osman Galloway, James B. Isaacs, John D. Rheumatology (Oxford) Clinical Science Objective. To determine whether time to treatment following symptom onset differs between RA patients according to autoantibody status. Methods. A single-centre retrospective analysis of a UK early RA inception cohort was first undertaken to identify those components of the patient journey that differed by serological subtype. Data from a UK national audit of early inflammatory arthritis patients was accessed to replicate the key finding. Results. A total of 173 RA patients were diagnosed over a 31-month period, of whom 80 (46%) were ACPA/RF double-seropositive (ACPA(+)/RF(+)), 53 (31%) ACPA(−)/RF(−), 17 (10%) ACPA(+)/RF(−) and 23 (13%) RF(+)/ACPA(−). Overall, ACPA(+)/RF(+) patients experienced significantly longer symptom duration before DMARD initiation. This was accounted for by delays in their presentation to primary care following symptom onset—a finding that was robustly confirmed in an independent dataset of 2192 UK early RA patients. In contrast, ACPA(−)/RF(−) patients were significantly more likely to experience delays in DMARD initiation after presenting to secondary care. Conclusion. Causes of treatment delays in early RA differ according to patients’ autoantibody status. More insidious symptom onset and/or distinct health-seeking behaviours among ACPA(+)/RF(+) patients may contribute to late presentations in primary care, whereas ACPA(−)/RF(−) patients experience delayed diagnosis and treatment in secondary care. These observations inform the research agenda, potentially influencing the design of service delivery for early arthritis patients. Oxford University Press 2016-10 2016-07-03 /pmc/articles/PMC5034219/ /pubmed/27373893 http://dx.doi.org/10.1093/rheumatology/kew261 Text en © The Author 2016. Published by Oxford University Press on behalf of the British Society for Rheumatology. http://creativecommons.org/licenses/by-nc/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Clinical Science
Pratt, Arthur G.
Lendrem, Dennis
Hargreaves, Ben
Aslam, Osman
Galloway, James B.
Isaacs, John D.
Components of treatment delay in rheumatoid arthritis differ according to autoantibody status: validation of a single-centre observation using national audit data
title Components of treatment delay in rheumatoid arthritis differ according to autoantibody status: validation of a single-centre observation using national audit data
title_full Components of treatment delay in rheumatoid arthritis differ according to autoantibody status: validation of a single-centre observation using national audit data
title_fullStr Components of treatment delay in rheumatoid arthritis differ according to autoantibody status: validation of a single-centre observation using national audit data
title_full_unstemmed Components of treatment delay in rheumatoid arthritis differ according to autoantibody status: validation of a single-centre observation using national audit data
title_short Components of treatment delay in rheumatoid arthritis differ according to autoantibody status: validation of a single-centre observation using national audit data
title_sort components of treatment delay in rheumatoid arthritis differ according to autoantibody status: validation of a single-centre observation using national audit data
topic Clinical Science
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5034219/
https://www.ncbi.nlm.nih.gov/pubmed/27373893
http://dx.doi.org/10.1093/rheumatology/kew261
work_keys_str_mv AT prattarthurg componentsoftreatmentdelayinrheumatoidarthritisdifferaccordingtoautoantibodystatusvalidationofasinglecentreobservationusingnationalauditdata
AT lendremdennis componentsoftreatmentdelayinrheumatoidarthritisdifferaccordingtoautoantibodystatusvalidationofasinglecentreobservationusingnationalauditdata
AT hargreavesben componentsoftreatmentdelayinrheumatoidarthritisdifferaccordingtoautoantibodystatusvalidationofasinglecentreobservationusingnationalauditdata
AT aslamosman componentsoftreatmentdelayinrheumatoidarthritisdifferaccordingtoautoantibodystatusvalidationofasinglecentreobservationusingnationalauditdata
AT gallowayjamesb componentsoftreatmentdelayinrheumatoidarthritisdifferaccordingtoautoantibodystatusvalidationofasinglecentreobservationusingnationalauditdata
AT isaacsjohnd componentsoftreatmentdelayinrheumatoidarthritisdifferaccordingtoautoantibodystatusvalidationofasinglecentreobservationusingnationalauditdata