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

Author

Ellingwood L1, Kudaeva F1, Schieir O2, Bartlett SJ3,4, Bessette L5, Boire G6, Hazlewood GS7, Hitchon C8, Keystone E9, Tin D10, Thorne C11, Bykerk VP12,13, Pope J1; CATCH Investigators. RMD Open. 2019 Nov 14;5(2):e000931. doi: 10.1136/rmdopen-2019-000931. eCollection 2019.

Author Information

1 Medicine, Division Rheumatology, Western University, London, Ontario, Canada.

2 McGill University Centre for Bioinformatics, Montreal, Québec, Canada.

3 Clinical Epidemiology, McGill University, Montreal, Québec, Canada.

4 Division of Rheumatology, Johns Hopkins, Baltimore, Maryland, USA.

5 Groupe de Recherche en Rhumatologie et Maladies Osseuses, Sainte-Foy, Québec, Canada.

6 Medicine, Division of Rheumatology, University of Sherbrooke, Sherbrooke, Quebec, Canada.

7 Medicine, Division of Rheumatology, University of Calgary, Calgary, Alberta, Canada.

8 Medicine, Division of Rheumatology, University of Manitoba, Winnipeg, Manitoba, Canada.

9 Medicine, Division of Rheumatology, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada.

10 Medicine, Suthlake Regional Health Centre, Newmarket, Ontario, Canada.

11 Medicine, Division of Rheumatology, Southlake Regional Health Centre, Newmarket, Ontario, Canada.

12 Rheumatology, Hospital for Special Surgery, New York City, New York, USA.

13 Mount Sinai Hospital, Toronto, Ontario, Canada.

Abstract

OBJECTIVE: 

Early rheumatoid arthritis (RA) treatment requires timely recognition. This large, multicentre study compared patient-reported vs physician-reported onset of early RA.

METHODS: 

Patients 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.

RESULTS: 

In 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.

CONCLUSION: 

Over 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.