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Factors associated with time to diagnosis in early rheumatoid arthritis

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Abstract

Early diagnosis and treatment yield optimal outcomes in rheumatoid arthritis (RA); thus, barriers to disease recognition must be identified and addressed. We determined the impact of sociodemographic factors, medical comorbidities, family history, and disease severity at onset on the time to diagnosis in early RA. The Canadian early ArThritis CoHort study data on 1,142 early RA patients were analyzed for predictors of time to diagnosis using regression analysis. Sociodemographic factors (age, sex, income strata, education, ethnicity), measures of disease activity (joint counts, DAS28 score, acute-phase reactants, patient global evaluation, function), family history, serology, chronic musculoskeletal and mental health conditions, and obesity at diagnosis were considered. In multivariate linear regression analysis, more swollen joints (β = −0.047 per joint, 95 % CI −0.085, −0.010, p = 0.014), higher erythrocyte sedimentation rate (ESR) (β = −0.012 per 1 mm/h, 95 % CI −0.022, −0.002, p = 0.0018), and worse patient global scores (β = −0.082 per 1 unit on a visual analogue scale, 95 % CI −0.158, −0.006, p = 0.034) at baseline predicted a shorter time to diagnosis. Anti-cyclic citrullinated peptide (anti-CCP) antibody positivity (β = 0.688, 95 % CI 0.261, 1.115, p = 0.002) and low income (annual <$20,000 β = 1.185, 95 % CI 0.227, 2.143, p = 0.015; annual $20,000–50,000 β = 0.933, 95 % CI 0.069, 1.798, p = 0.034) increased time to diagnosis. In the logistic regression models, the odds of being diagnosed within 6 months of symptom onset were increased for each swollen joint present [odds ratio (OR) 1.04, 95 % CI 1.02–1.06 per joint], each 1 mm/h elevation in the ESR (OR 1.01, 95 % CI 1.00–1.02), and decreased for patients who were either rheumatoid factor or anti-CCP positive compared to both factors being negative (OR 0.68, 95 % CI 0.51–0.91). Higher disease activity results in a more rapid diagnosis for Canadian patients with early RA, but those with lower income have delays in diagnosis. Strategies to identify patients with a less severe disease presentation and in lower socioeconomic strata are needed to ensure equal opportunity for optimal management.

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Acknowledgments

Daming Lin provided assistance with analysis.

Conflict of interest

The CATCH study was designed and implemented by the investigators and financially supported initially by Amgen Canada Inc. and Pfizer Canada Inc. via an unrestricted research grant since inception. As of 2010, further support was provided by Hoffmann-La Roche Ltd., United Chemicals of Belgium (UCB) Canada Inc., Bristol-Myers Squibb Canada Co., Abbvie Laboratories Ltd., and Janssen Biotech Inc. (a wholly owned subsidiary of Johnson & Johnson Inc.).

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Authors and Affiliations

  1. Departments of Medicine and Community Health Sciences, University of Calgary, 3330 Hospital Dr NW, Calgary, AB, T2N 4N1, Canada

    Cheryl Barnabe

  2. Rheumatology, Mount Sinai Hospital, University of Toronto, Toronto, Canada

    Juan Xiong & Vivian P. Bykerk

  3. Department of Medicine, University of Western Ontario, London, Canada

    Janet E. Pope

  4. Département de Médecine, Université de Sherbrooke, Sherbrooke, Canada

    Gilles Boire

  5. Department of Medicine, University of Manitoba, Winnipeg, Canada

    Carol Hitchon

  6. Department of Rheumatology, Centre Hospitalier de l’Universite de Montreal, Montreal, Canada

    Boulos Haraoui

  7. Southlake Regional Health Centre, Newmarket, Canada

    J. Carter Thorne & Diane Tin

  8. Department of Medicine, University of Toronto, Toronto, Canada

    Edward C. Keystone

  9. Hospital for Special Surgery, Weill Cornell Medical College, New York, NY, USA

    Vivian P. Bykerk

Authors
  1. Cheryl Barnabe
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  2. Juan Xiong
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  3. Janet E. Pope
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  4. Gilles Boire
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  5. Carol Hitchon
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  6. Boulos Haraoui
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  7. J. Carter Thorne
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  8. Diane Tin
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  9. Edward C. Keystone
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  10. Vivian P. Bykerk
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Consortia

Canadian early ArThritis CoHort (CATCH) Study Investigators

Corresponding author

Correspondence to Cheryl Barnabe.

Additional information

The members of the Canadian early ArThritis CoHort (CATCH) study Investigators are given in “Appendix.”

Appendix: CATCH investigators

Appendix: CATCH investigators

Vandana Ahluwalia, Pooneh Akhavan, Hector Arbillaga, Cheryl Barnabe, Murray Baron, Mary Bell, William Bensen, Gilles Boire, Vivian Bykerk, Alf Cividino, Ines Colmegna, Paul Haraoui, Carol Hitchon, Shahin Jamal, Ed Keystone, Alice Klinkhoff, Majed Khraishi, Maggie Larche, Chris Lyddell, Henri Menard, Dianne Mosher, Bindu Nair, Erin Norris, Chris Penney, Janet Pope, Laurence Rubin, Emily Shaw, Evelyn Sutton, Carter Thorne, Michel Zummer.

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Barnabe, C., Xiong, J., Pope, J.E. et al. Factors associated with time to diagnosis in early rheumatoid arthritis. Rheumatol Int 34, 85–92 (2014). https://doi.org/10.1007/s00296-013-2846-5

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  • DOI: https://doi.org/10.1007/s00296-013-2846-5

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