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Time to Disease-modifying Antirheumatic Drug Treatment in Rheumatoid Arthritis and Its Predictors: A National, Multicenter, Retrospective Cohort
The Journal of Rheumatology, 08/16/2012
Clinical Article
Tavares R et al. – Fewer than 50% of patients with rheumatoid arthritis are treated with disease–modifying antirheumatic drugs (DMARD) within 6 months from symptom onset. Time to referral to rheumatology represents the greatest component delay to treatment. Concomitant musculoskeletal condition was the most prominent predictor of delayed initiation of DMARD.
Methods- A historical inception cohort of 339 patients with RA randomly selected from 18 rheumatology practices was audited.
- The proportion that initiated DMARD treatment within 6 months from symptom onset was estimated using Kaplan–Meier analysis.
- Time to each component of the care pathway was estimated.
- Multivariable modeling was used to determine predictors of early treatment using 12 preselected variables available in the clinical charts.
- Bootstrapping was used to validate the model.
- Within 6 months from symptom onset, 41% (95% CI 36%–46%) of patients were treated with DMARD.
- Within 6 months from symptom onset, 41% (95% CI 36%–46%) of patients were treated with DMARD.
- Events preceding rheumatology referral accounted for 78.1% of the time to treatment.
- The most prominent predictor of increased time to treatment was a concomitant musculoskeletal condition, such as osteoarthritis or fibromyalgia.
- The significance of other variables was less consistent across the models investigated.
- Included variables accounted for 0.69 ± 0.03 of the variability in the model.
