Time to disease-modifying antirheumatic drug treatment in rheumatoid arthritis and its predictors: a national, multicenter, retrospective cohort.
OBJECTIVE
To determine the proportion of patients with rheumatoid arthritis (RA) under rheumatologic care treated with disease-modifying antirheumatic drugs (DMARD) within 6 months from symptom onset and the components of time to treatment and its predictors.


METHODS
A historical inception cohort of 339 patients with RA randomly selected from 18 rheumatology practices was audited. The proportion that initiated DMARD treatment within 6 months from symptom onset was estimated using Kaplan-Meier analysis. Time to each component of the care pathway was estimated. Multivariable modeling was used to determine predictors of early treatment using 12 preselected variables available in the clinical charts. Bootstrapping was used to validate the model.


RESULTS
Within 6 months from symptom onset, 41% (95% CI 36%-46%) of patients were treated with DMARD. The median time to treatment was 8.4 (interquartile range 3.8-24) months. Events preceding rheumatology referral accounted for 78.1% of the time to treatment. The most prominent predictor of increased time to treatment was a concomitant musculoskeletal condition, such as osteoarthritis or fibromyalgia. The significance of other variables was less consistent across the models investigated. Included variables accounted for 0.69 ± 0.03 of the variability in the model.


CONCLUSIONS
Fewer than 50% of patients with RA are treated with DMARD within 6 months from symptom onset. Time to referral to rheumatology represents the greatest component delay to treatment. Concomitant musculoskeletal condition was the most prominent predictor of delayed initiation of DMARD. Implications of these and other findings warrant further investigation.
McMaster University, Hamilton, ON, Canada. ruben.tavares@sympatico.ca
Ruben
R
Tavares
Janet E
JE
Pope
Jean-Luc
JL
Tremblay
Carter
C
Thorne
Vivian P
VP
Bykerk
Juris
J
Lazovskis
Kenneth L N
KL
Blocka
Mary J
MJ
Bell
Diane
D
Lacaille
Carol A
CA
Hitchon
Avril A
AA
Fitzgerald
Wesley K
WK
Fidler
Arthur A M
AA
Bookman
James M
JM
Henderson
Dianne P
DP
Mosher
Dalton E
DE
Sholter
Majed
M
Khraishi
Boulos
B
Haraoui
Hong
H
Chen
Xiuying
X
Li
Andreas
A
Laupacis
Gilles
G
Boire
George
G
Tomlinson
Claire
C
Bombardier
D000328:Adult; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000453:epidemiology; D002170:Canada; D015331:Cohort Studies; D015897:Comorbidity; D019468:Disease Management; D005260:Female; D005356:Fibromyalgia / Q000453:epidemiology; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000453:epidemiology; D012189:Retrospective Studies; D013997:Time Factors
D018501:Antirheumatic Agents