title: Components of treatment delay in rheumatoid arthritis differ according to autoantibody status: validation of a single-centre observation using national audit data.
abstract: OBJECTIVE
  To determine whether time to treatment following symptom onset differs between RA patients according to autoantibody status.
  
  
  METHODS
  A single-centre retrospective analysis of a UK early RA inception cohort was first undertaken to identify those components of the patient journey that differed by serological subtype. Data from a UK national audit of early inflammatory arthritis patients was accessed to replicate the key finding.
  
  
  RESULTS
  A total of 173 RA patients were diagnosed over a 31-month period, of whom 80 (46%) were ACPA/RF double-seropositive (ACPA(+)/RF(+)), 53 (31%) ACPA(-)/RF(-), 17 (10%) ACPA(+)/RF(-) and 23 (13%) RF(+)/ACPA(-) Overall, ACPA(+)/RF(+) patients experienced significantly longer symptom duration before DMARD initiation. This was accounted for by delays in their presentation to primary care following symptom onset-a finding that was robustly confirmed in an independent dataset of 2192 UK early RA patients. In contrast, ACPA(-)/RF(-) patients were significantly more likely to experience delays in DMARD initiation after presenting to secondary care.
  
  
  CONCLUSIONS
  Causes of treatment delays in early RA differ according to patients' autoantibody status. More insidious symptom onset and/or distinct health-seeking behaviours among ACPA(+)/RF(+) patients may contribute to late presentations in primary care, whereas ACPA(-)/RF(-) patients experience delayed diagnosis and treatment in secondary care. These observations inform the research agenda, potentially influencing the design of service delivery for early arthritis patients.
authors.affiliation: National Institute for Health Research Newcastle Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust and Newcastle University, Newcastle upon Tyne arthur.pratt@ncl.ac.uk.
authors.forename: Arthur G
authors.initials: AG
authors.lastname: Pratt
authors.affiliation: National Institute for Health Research Newcastle Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust and Newcastle University, Newcastle upon Tyne.
authors.forename: Dennis
authors.initials: D
authors.lastname: Lendrem
authors.affiliation: National Institute for Health Research Newcastle Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust and Newcastle University, Newcastle upon Tyne.
authors.forename: Ben
authors.initials: B
authors.lastname: Hargreaves
authors.affiliation: National Institute for Health Research Newcastle Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust and Newcastle University, Newcastle upon Tyne.
authors.forename: Osman
authors.initials: O
authors.lastname: Aslam
authors.affiliation: Academic Department of Rheumatology, King's College London, King's College London School of Medicine, Weston Education Centre, London, UK.
authors.forename: James B
authors.initials: JB
authors.lastname: Galloway
authors.affiliation: National Institute for Health Research Newcastle Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust and Newcastle University, Newcastle upon Tyne.
authors.forename: John D
authors.initials: JD
authors.lastname: Isaacs
mesh_terms: D000368:Aged; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000276:immunology; D001323:Autoantibodies / Q000097:blood*; D005194:Family Practice / Q000706:statistics & numerical data; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D061665:Time-to-Treatment
chemical_list: D018501:Antirheumatic Agents; D001323:Autoantibodies
keywords: anti-citrullinated peptide; auto-antibodies; rheumatoid arthritis; rheumatoid factor