title: Lag time between onset of symptoms and access to rheumatology care and DMARD therapy in a cohort of patients with rheumatoid arthritis.
abstract: OBJECTIVE
  To study demographic and clinical variables associated with a longer delay in disease modifying antirheumatic drug (DMARD) therapy initiation in a cohort of patients with rheumatoid arthritis (RA).
  
  
  METHODS
  We studied 527 new RA patients (74.3% female, median age at symptom onset 55 yrs) in a hospital setting who fulfilled the ACR criteria for the diagnosis of RA. Demographic, clinical, laboratory, and treatment variables were collected longitudinally into a computerized research database. Risk factors for delay in use of DMARD therapy and first evaluation by a rheumatologist were analyzed using a Cox regression model.
  
  
  RESULTS
  The median lag time between symptom onset and first rheumatologist encounter was 17 months and between onset of symptoms and first DMARD therapy 19 months. Variables associated with longer delay to DMARD therapy were the lag time between symptom onset and first rheumatologist visit (RR 0.73, 95% CI 0.71-0.76) and years of education. Variables associated with longer delay in first visit with rheumatologist were swollen/tender joint count, age at symptom onset, home support, labor force status, marital status, and years of education.
  
  
  CONCLUSIONS
  Awareness of factors associated with a longer delay in access to rheumatology care and DMARD therapy may help break down barriers that prevent their early access, irrespective of patient age, socioeconomic status, initial symptoms, or need for treatment.
authors.affiliation: Rheumatology and the Clinical Pharmacology Service, Hospital Clínico San Carlos, Madrid, Spain. chernandez@pulso.com
authors.forename: C
authors.initials: C
authors.lastname: Hernández-García
authors.forename: E
authors.initials: E
authors.lastname: Vargas
authors.forename: L
authors.initials: L
authors.lastname: Abásolo
authors.forename: C
authors.initials: C
authors.lastname: Lajas
authors.forename: B
authors.initials: B
authors.lastname: Bellajdell
authors.forename: I C
authors.initials: IC
authors.lastname: Morado
authors.forename: P
authors.initials: P
authors.lastname: Macarrón
authors.forename: E
authors.initials: E
authors.lastname: Pato
authors.forename: B
authors.initials: B
authors.lastname: Fernández-Gutiérrez
authors.forename: A
authors.initials: A
authors.lastname: Bañares
authors.forename: J A
authors.initials: JA
authors.lastname: Jover
mesh_terms: D000328:Adult; D000368:Aged; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000401:mortality; D015331:Cohort Studies; D003710:Demography; D005260:Female; D006297:Health Services Accessibility; D006786:Hospitals, Urban; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012307:Risk Factors; D013030:Spain; D016019:Survival Analysis; D015996:Survival Rate; D013997:Time Factors
chemical_list: D018501:Antirheumatic Agents