title: From Symptoms to Diagnosis: An Observational Study of the Journey of Rheumatoid Arthritis Patients in Saudi Arabia.
abstract: OBJECTIVE
  Rheumatoid arthritis (RA) is often not diagnosed or treated quickly enough to alter outcomes. We aimed to evaluate the lag times from disease onset to first clinical consultation and diagnosis and to identify factors contributing to delayed diagnosis in Saudi Arabia.
  
  
  METHODS
  This retrospective, multicenter study collected data on 250 patients, from six hospitals in Saudi Arabia, who met the 2010 American College of Rheumatology criteria for RA.
  
  
  RESULTS
  The patients mean age was 43.3±12.0 years (mean disease duration: 6.6±5.8 years). The majority were female (84.8%) and presented with joint pain during RA onset (83.6%). On average, they consulted 4.3±2.5 physicians from the first symptoms to the final diagnosis. The mean time from onset to first physician visit (lag 1) was 6.2±5.5 months, whereas the mean time was 30.2±16.0 months between the initial visit and final RA diagnosis (lag 2). Only 3.2% of patients initially sought consultation from a rheumatologist, while 67.2%, 23.6%, and 6.0% first met with orthopedic surgeons, general practitioners, and non-rheumatologists, respectively. Non-rheumatologists offered diagnoses in 24.4% of cases while rheumatologists diagnosed 75.6%. The absence of early hand/wrist involvement and fatigue were associated with delayed RA diagnosis (long lag 2; p<0.010). Moreover, geographic distribution influenced RA diagnosis, with rural patients experiencing a greater delay than urban patients (p<0.0001).
  
  
  CONCLUSIONS
  Failure of patients to be seen by rheumatologists at RA onset delayed diagnosis and treatment. Thus, RA diagnosis can be accelerated by encouraging early referral to rheumatologists.
authors.affiliation: Department of Medicine, Heraa General Hospital, Makkah, Saudi Arabia.
authors.forename: Waleed
authors.initials: W
authors.lastname: Hussain
authors.affiliation: Department of Medicine, Umm Alqura University, Makkah, Saudi Arabia; Department of Medicine, Alnoor General Hospital, Makkah, Saudi Arabia.
authors.forename: Abdulsalam
authors.initials: A
authors.lastname: Noorwali
authors.affiliation: Department of Medicine, Dr. Soleiman Fakeeh Hospital, Jeddah, Saudi Arabia.
authors.forename: Nahid
authors.initials: N
authors.lastname: Janoudi
authors.affiliation: Department of Medicine, King Abdulaziz Hospital and Oncology Center, Jeddah, Saudi Arabia.
authors.forename: Maatouqa
authors.initials: M
authors.lastname: Baamer
authors.affiliation: Department of Medicine, Specialized Medical Center, Riyadh, Saudi Arabia.
authors.forename: Lina
authors.initials: L
authors.lastname: Kebbi
authors.affiliation: Department of Medicine, Specialized Medical Center, Riyadh, Saudi Arabia.
authors.forename: Hanady
authors.initials: H
authors.lastname: Mansafi
authors.affiliation: Alzaidi Chair of Research in Rheumatic Diseases, Umm Alqura University, Makkah, Saudi Arabia.
authors.forename: Ashraf
authors.initials: A
authors.lastname: Ibrahim
authors.affiliation: Alzaidi Chair of Research in Rheumatic Diseases, Umm Alqura University, Makkah, Saudi Arabia.
authors.forename: Shereen
authors.initials: S
authors.lastname: Gohary
authors.affiliation: Alzaidi Chair of Research in Rheumatic Diseases, Umm Alqura University, Makkah, Saudi Arabia.
authors.forename: Joan
authors.initials: J
authors.lastname: Minguet
authors.affiliation: Department of Medicine, Umm Alqura University, Makkah, Saudi Arabia; Department of Medicine, Dr. Soleiman Fakeeh Hospital, Jeddah, Saudi Arabia; Alzaidi Chair of Research in Rheumatic Diseases, Umm Alqura University, Makkah, Saudi Arabia.
authors.forename: Hani
authors.initials: H
authors.lastname: Almoallim
keywords: Arthritis, Rheumatoid; Diagnosis, Disease Management; Therapeutics
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