title: Diagnostic and therapeutic delay of rheumatoid arthritis and its relationship with health care devices in Catalonia. The AUDIT study.
abstract: OBJECTIVE
  Diagnosis and therapy of patients with early onset rheumatoid arthritis (RA) is influenced by accessibility to specialized care devices. We attempted to analyze the impact of their availability.
  
  
  METHODS
  We analyzed time related to diagnosis delay measuring: 1) Time from first clinical symptoms to the first visit with the Rheumatologist; 2) Time from referral to the first visit of Rheumatology; 3) Time between first symptom until final diagnosis; 4) time between first symptom until the initiation of the first disease-modifying antirheumatic drug (DMARD). The presence of these 6 rheumatology devices was defined: 1) early arthritis monographic clinics, 2) RA monographic clinics, 3) Mechanisms for fast programming, 4) Algorithms for referral from primary care (PC), 5) rheumatology consultation services in PC and 6) consulting services in PC.
  
  
  RESULTS
  The mean time from onset of symptoms to diagnosis or the establishment of a DMARD in RA patients in Catalonia is very long (11 months). Patients seen in rheumatology devices such as RA monographic clinics, rheumatology consultation in PC and specially in early arthritis clinics are treated early with DMARDs.
  
  
  CONCLUSIONS
  the existence of monographic clinics or consulting in primary care centers is essential to improve early care of RA patients.
authors.affiliation: Hospital Moisès Broggi, Sant Joan Despí, Barcelona, España; Hospital de l'Hospitalet, Barcelona, España. Electronic address: vancor@yahoo.com.
authors.forename: Hèctor
authors.initials: H
authors.lastname: Corominas
authors.affiliation: Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España.
authors.forename: Javier
authors.initials: J
authors.lastname: Narváez
authors.affiliation: Hospital Universitari de la Santa Creu, i Sant Pau, Barcelona, España.
authors.forename: César
authors.initials: C
authors.lastname: Díaz-Torné
authors.affiliation: Hospital Universitari Mútua de Terrassa, Barcelona, España.
authors.forename: Georgina
authors.initials: G
authors.lastname: Salvador
authors.affiliation: Hospital Clínic Universitari, Barcelona, España.
authors.forename: María Eugenia
authors.initials: ME
authors.lastname: Gomez-Caballero
authors.affiliation: Hospital de Viladecans, Barcelona, España.
authors.forename: Diana
authors.initials: D
authors.lastname: de la Fuente
authors.affiliation: Hospital Residència Sant Camil, Barcelona, España.
authors.forename: Ester
authors.initials: E
authors.lastname: Campoy
authors.affiliation: Hospital Moisès Broggi, Sant Joan Despí, Barcelona, España; Hospital de l'Hospitalet, Barcelona, España.
authors.forename: Daniel
authors.initials: D
authors.lastname: Roig-Vilaseca
authors.affiliation: Hospital de Palamós, Girona, España.
authors.forename: Teresa
authors.initials: T
authors.lastname: Clavaguera
authors.affiliation: Hospital Sant Pau i Santa Tecla, Tarragona, España.
authors.forename: Rosa
authors.initials: R
authors.lastname: Morlà
authors.affiliation: Hospital Moisès Broggi, Sant Joan Despí, Barcelona, España; Hospital de l'Hospitalet, Barcelona, España.
authors.forename: Vicenç
authors.initials: V
authors.lastname: Torrente-Segarra
authors.affiliation: Hospital de Tortosa Verge de la Cinta, Tarragona, España.
authors.forename: Xavier
authors.initials: X
authors.lastname: Arasa
authors.affiliation: Hospital Clínic Universitari, Barcelona, España.
authors.forename: José Alfredo
authors.initials: JA
authors.lastname: Gomez-Puerta
authors.affiliation: Institut Poal de Reumatologia, Barcelona, España.
authors.forename: Ingrid
authors.initials: I
authors.lastname: Möller
authors.affiliation: Hospital General Universitari de la Vall d'Hebrón, Barcelona, España.
authors.forename: Cayetano
authors.initials: C
authors.lastname: Alegre
authors.affiliation: Hospital Universitari Parc Taulí de Sabadell, Barcelona, España.
authors.forename: Eduard
authors.initials: E
authors.lastname: Graell
authors.affiliation: Hospital General de Granollers, Barcelona, España.
authors.forename: Andrés
authors.initials: A
authors.lastname: Ponce
authors.affiliation: Parc de Salut Mar, Barcelona, España.
authors.forename: María Pilar
authors.initials: MP
authors.lastname: Lisbona
authors.affiliation: Hospital de Mollet, Barcelona, España.
authors.forename: Carolina
authors.initials: C
authors.lastname: Pérez-Garcia
authors.affiliation: Hospital Moisès Broggi, Sant Joan Despí, Barcelona, España; Hospital de l'Hospitalet, Barcelona, España.
authors.forename: Ramon
authors.initials: R
authors.lastname: Fíguls
authors.affiliation: Hospital de Sant Boi, Barcelona, España.
authors.forename: Elena
authors.initials: E
authors.lastname: Sirvent
authors.affiliation: Centre Internacional de Medicina Avançada (CIMA), Barcelona, España.
authors.forename: Violan
authors.initials: V
authors.lastname: Poca
authors.affiliation: Hospital Clínic Universitari, Barcelona, España.
authors.forename: Raimon
authors.initials: R
authors.lastname: Sanmartí
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000175:diagnosis* / Q000188:drug therapy; D003430:Cross-Sectional Studies; D057210:Delayed Diagnosis / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D011320:Primary Health Care; D012017:Referral and Consultation / Q000706:statistics & numerical data; D013030:Spain; D013997:Time Factors
chemical_list: D018501:Antirheumatic Agents
keywords: AUDIT study; Artritis reumatoide de inicio reciente; Dispositivos de asistenciales especializados; Early onset rheumatoid arthritis; Estudio AUDIT; Health care devices