A quarter of patients time their early rheumatoid arthritis onset differently than physicians. Issue 2 (14th November 2019)

• Record Type: Journal Article
• Authors: Ellingwood, Leah; Kudaeva, Fatima; Schieir, Orit; Bartlett, Susan J; Bessette, Louis; Boire, Gilles; Hazlewood, Glen S; Hitchon, Carol; Keystone, Edward; Tin, Diane; Thorne, Carter; Bykerk, Vivian P; Pope, Janet
• Other Names: author non-byline.; Baron Murray author non-byline.; Bessette Louis author non-byline.; Boire Gilles author non-byline.; Bykerk Vivian author non-byline.; Colmegna Ines author non-byline.; Fallavollita Sabrina author non-byline.; Haaland Derek author non-byline.; Haraoui Paul author non-byline.; Hazlewood Glen author non-byline.; Hitchon Carol author non-byline.; Jamal Shahin author non-byline.; Joshi Raman author non-byline.; Keystone Ed author non-byline.; Nair Bindu author non-byline.; Panopoulos Peter author non-byline.; Pope Janet author non-byline.; Rubin Laurence author non-byline.; Thorne Carter author non-byline.; Villeneuve Edith author non-byline.; Zummer Michel author non-byline.
• Is Part Of: RMD open. Volume 5:Issue 2(2019)
• Publication Date: 2019-11-14
• Subjects: rheumatoid arthritis -- early rheumatoid arthritis -- symptom onset -- early inflammatory arthritis -- RF -- ACPA -- incident cohort; Musculoskeletal system -- Diseases -- Periodicals; Rheumatism -- Periodicals; 616.7005
• DOI: 10.1136/rmdopen-2019-000931
• Languages: English
• ISSNs: 2056-5933

Abstract

Abstract : Objective: Early rheumatoid arthritis (RA) treatment requires timely recognition. This large, multicentre study compared patient-reported vs physician-reported onset of early RA. Methods: Patients from the Canadian Early ArThritis CoHort with early/suspected RA (persistent synovitis <1 year) completed questionnaires asking about the date of symptom onset; and rheumatologists date of onset for persistent synovitis. Groups with similar reported timing (patient and physician) versus differing timing of 30 days or more were compared. Results: In 2683 patients, the median patient symptom duration (IQR) was 178 days (163) and physician-reported duration was 166 (138). 1940 (72%) patients had similar patient-reported and physician-reported onset (<30 days), whereas 497 (18%) reported onset 30 or more days preceding physicians, and 246 (9%) 30 or more days after physicians. Patients reporting onset preceding physicians had lower baseline Disease Activity Score based on 28 joint count, swollen joint counts and erythrocyte sedimentation rate (p<0.05). Patients reporting onset after physicians were more likely to be rheumatoid factor positive (p<0.001) and had higher anticitrullinated protein antibody titres (p<0.009). Regression showed low income, smoking, fibromyalgia, osteoarthritis and baseline non-methotrexate non-biological disease-modifying antirheumatic drug use were predictors for longer patient-reported symptoms. At 12 months, patients reporting longer symptom duration than physicians had lower rates of Simplified Disease Activity Index remission and higher physician global assessments. Conclusion: Over one-fourth of patients reported differences of >1 month in symptom onset from their rheumatologist. Patients with longer symptom durations had less improvement at 1 year, which may be reflective of comorbid musculoskeletal conditions.