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DMARD introduced within 6 months for 41% of rheumatoid arthritis patients
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Less than half of patients with rheumatoid arthritis began disease-modifying antirheumatic drugs within 6 months of symptom onset, according to study results.
Researchers reviewed charts of 339 randomly selected patients (median age, 50 years; 75.5% women) with rheumatoid arthritis (RA) from 18 Canadian rheumatology practices. Kaplan-Meier analysis was used to estimate the proportion of patients who initiated disease-modifying antirheumatic drugs (DMARD) within 6 months of symptom onset. Twelve preselected variables and multivariable modeling were used to determine predictors of early treatment; bootstrapping provided validation.
Forty-one percent of patients (n=139) were treated with DMARDs within 6 months of symptom onset (95% CI, 36%-46%); researchers found 21% (n=70) began therapy within 3 months (95% CI, 16%-25%). Median time from symptom onset to DMARD treatment was 8.4 months (IQR=3.8-24 months).
Almost 40% of patients began DMARD treatment before a definitive RA diagnosis, with events prior to rheumatology referrals accounting for 78.1% of time to treatment. Concomitant musculoskeletal conditions, such as osteoarthritis or fibromyalgia, were prominent predictors of increased time to treatment. Older age at symptom onset (HR=1.01; P=.02) and the absence of a concomitant musculoskeletal condition (HR=1.45; P=.002) were associated with less time to DMARD therapy. Other variables were less consistent; the bootstrap models’ c-index was 0.69 ± 0.03.
“The average patient was treated at first presentation to rheumatology, prior to the documentation of definitive diagnosis,” the researchers said. “Earlier referral to rheumatology and distinction of RA from other musculoskeletal conditions may allow for decreased time to treatment. A contemporary re-evaluation is required to corroborate and further investigate the findings from this study.”
Disclosure: See the study for a full list of relevant disclosures.
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