title: Time to treatment for new patients with rheumatoid arthritis in a major metropolitan city.
abstract: OBJECTIVE
  To determine the proportion of patients with rheumatoid arthritis (RA) seen by rheumatologists and treated with disease-modifying antirheumatic drugs (DMARD) within 3 months of symptom onset, to determine where treatment delays occur, and to identify contributing factors.
  
  
  METHODS
  A retrospective cohort study in which adult patients with RA, diagnosed between January 1, 2003, and May 31, 2006, were recruited from rheumatologists' offices to participate in a telephone survey and chart review. The percentage treated with DMARD within 3 months of symptom onset was determined, along with median times for delay. Factors contributing to the delay were explored using multivariable logistic regression.
  
  
  RESULTS
  Our study included 204 patients. Within 3 months of symptoms, 22.6% (95% CI 16.8%, 28.3%) received DMARD and within 6 months, 47.6% (95% CI 40.7%, 54.4%). The median time from symptom onset to DMARD was 6.4 months [interquartile range (IQR) 3.3, 12.0] with a median time from RA diagnosis by a rheumatologist to DMARD of 0.0 months (IQR 0.0, 1.0). Higher baseline swollen joint counts resulted in earlier treatment. Age, sex, education, comorbidity, rheumatologist practice type, and years since the physician's graduation did not affect time to treatment.
  
  
  CONCLUSIONS
  Fewer than 25% of patients referred to rheumatologists were treated within 3 months of symptom onset. Identification of inflammatory arthritis and referral to rheumatologists are the key factors in timely care, because once patients are seen there is no delay to treatment. Future resources should be focused on development and evaluation of interventions to facilitate rapid triage, referral, and assessment by a rheumatologist.
authors.affiliation: University of British Columbia, Vancouver, British Columbia, Canada. shahin.jamal@vch.ca
authors.forename: Shahin
authors.initials: S
authors.lastname: Jamal
authors.forename: Shabbir M H
authors.initials: SM
authors.lastname: Alibhai
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Badley
authors.forename: Claire
authors.initials: C
authors.lastname: Bombardier
mesh_terms: D000328:Adult; D000368:Aged; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000175:diagnosis* / Q000188:drug therapy*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009864:Ontario; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013038:Specialization / Q000706:statistics & numerical data; D013997:Time Factors; D019037:Urban Health Services / Q000706:statistics & numerical data*
chemical_list: D018501:Antirheumatic Agents