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Delay in diagnosis of rheumatoid arthritis: reasons and trends over a decade

  • Observational Research
  • Published:
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Abstract

Introduction

Delay in diagnosis and treatment initiation often lead to poorer outcomes in rheumatoid arthritis (RA). Most of the data on delay in diagnosis and management are from western population with no data from India. Additionally, with improved health care services, whether the delay has changed over years is not known. In this longitudinal observational study, we investigated delay to diagnosis and disease-modifying antirheumatic drugs (DMARDs) initiation over past 9 years.

Methods

Patients aged ≥ 18 years having RA fulfilling 2010 ACR/EULAR criteria were enrolled from January to June in years 2012, 2017 and 2021. Diagnoses received before presenting to clinic, socioeconomic status, educational level and other demographic variables were recorded.

Results

Each year, 323 patients (mean age 49.5–52.01 years) were enrolled. There was a significant reduction in delay in diagnosis from a median (IQR) of 36 (12–84, range 1–288) months in 2012 to 12 (4–36, range 1–180) months in 2017 and 10 (5–24, range 1–120) months) in 2021 (p < 0.0001). A significant improvement in time to initiating DMARDs from 2012 [48 (24–96) months] to 2017 [12 (6–36) months] (p < 0.0001) and from 2017 to 2021 [12 (5–24) months] (p = 0.03) was seen. Higher education, more patients opting for treatment from rheumatologists, and urbanisation contributed significantly to improvement in delay. There was no impact of age or gender on delay.

Conclusion

Delay in diagnosis has improved significantly between 2012 and 2021. However, delay still remains long as most patients miss the 3-month therapeutic window. Future work focussing on reasons for delays in the patient pathway could help improve consultation pathways in India.

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Data availability

Data can be made available as and when requested.

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Acknowledgements

We would like to acknowledge Dr Amita Aggarwal (Department of Clinical Immunology & Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India), Dr Sapan C Pandya (Vedanta Institute of Medical Sciences, Ahmedabad, India) and Dr Banwari Sharma (Niramaya Health Care, Jaipur, India) for their inputs to the manuscript.

Funding

No specific funding was received from any bodies in the public, commercial or not-for-profit sectors to carry out the work described in this article.

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Authors and Affiliations

  1. Department of Clinical Immunology & Rheumatology, SMS Medical College and Hospital, Jaipur, India

    Avinash Jain

  2. Department of Clinical Immunology & Rheumatology, Centre for Arthritis and Rheumatism Excellence (CARE), 16/554-2, NH 47, Nettoor, Cochin, Kerala, 682040, India

    Sanjana Joseph, Jeenamol James, Tintus Sara James & Padmanabha Shenoy

  3. Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK

    Kanta Kumar

  4. Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK

    Karim Raza

  5. NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK

    Karim Raza

  6. Department of Rheumatology, Sandwell and West Birmingham NHS Trust, Birmingham, UK

    Karim Raza

  7. Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK

    Sheila Greenfield

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  1. Avinash Jain
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  2. Sanjana Joseph
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  8. Padmanabha Shenoy
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Contributions

Conceptualization: PS, AJ, KR and KK; methodology and data analyses PS, Joseph S, AJ. Acquisition: PS, Joseph S, JJ, TSJ; writing—original draft: AJ, PS, Joseph S, JJ; draft review and critical appraisal—all authors have reviewed and critically appraised the draft. All the authors have approved the final manuscript and take full responsibility for the integrity of the data and the contents of the manuscript.

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Correspondence to Padmanabha Shenoy.

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Jain, A., Joseph, S., James, J. et al. Delay in diagnosis of rheumatoid arthritis: reasons and trends over a decade. Rheumatol Int 43, 503–508 (2023). https://doi.org/10.1007/s00296-022-05187-0

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