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Vol. 12. Issue 3.
Pages 146-150 (May - June 2016)
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Vol. 12. Issue 3.
Pages 146-150 (May - June 2016)
Brief Report
DOI: 10.1016/j.reumae.2015.08.001
Diagnostic and Therapeutic Delay of Rheumatoid Arthritis and its Relationship With Health Care Devices in Catalonia. The AUDIT Study
Retraso diagnóstico y terapéutico de la artritis reumatoide y su relación con dispositivos asistenciales en Catalunya. Estudio AUDIT
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Hèctor Corominasa,b,
Corresponding author
vancor@yahoo.com

Corresponding author.
, Javier Narváezc, César Díaz-Tornéd, Georgina Salvadore, María Eugenia Gomez-Caballerof, Diana de la Fuenteg, Ester Campoyh, Daniel Roig-Vilasecaa,b, Teresa Clavaguerai, Rosa Morlàj, Vicenç Torrente-Segarraa,b, Xavier Arasak, José Alfredo Gomez-Puertaf, Ingrid Möllerl, Cayetano Alegrem, Eduard Graelln, Andrés Ponceo, María Pilar Lisbonap, Carolina Pérez-Garciaq, Ramon Fígulsa,b, Elena Sirventr, Violan Pocas, Raimon Sanmartíf
a Hospital Moisès Broggi, Sant Joan Despí, Barcelona, Spain
b Hospital de l’Hospitalet, Spain
c Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain
d Hospital Universitari de la Santa Creu i Sant Pau, Barcelona, Spain
e Hospital Universitari Mútua de Terrassa, Barcelona, Spain
f Hospital Clínic Universitari, Barcelona, Spain
g Hospital de Viladecans, Barcelona, Spain
h Hospital Residència Sant Camil, Barcelona, Spain
i Hospital de Palamós, Girona, Spain
j Hospital Sant Pau i Santa Tecla, Tarragona, Spain
k Hospital de Tortosa Verge de la Cinta, Tarragona, Spain
l Institut Poal de Reumatologia, Barcelona, Spain
m Hospital General Universitari de la Vall d’Hebron, Barcelona, Spain
n Hospital Universitari Parc Taulí de Sabadell, Barcelona, Spain
o Hospital General de Granollers, Barcelona, Spain
p Parc de Salut Mar, Barcelona, Spain
q Hospital de Mollet, Bareclona, Spain
r Hospital de Sant Boi, Barcelona, Spain
s Centre Internacional de Medicina Avançada (CIMA), Barcelona, Spain
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Tables (4)
Table 1. Disease Course According to the Available Rheumatology Care Features: Dedicated Early Arthritis Clinic.
Table 2. Disease Course According to the Available Rheumatology Care Features: Rheumatology Unit in Primary Care and Counseling Services.
Table 3. Relationship Between Time of Symptom Onset to Initiation of First Disease-modifying Antirheumatic Drug and the Rheumatology Care Features.
Table 4. Relationship Between Dedicated Early Arthritis and Rheumatoid Arthritis Clinics, Rheumatology Units in Primary Care and Time From Onset of First Symptom to First Treatment With DMARDs: Multiple Regression Analysis.
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Abstract
Objective

Diagnosis and therapy of patients with early onset rheumatoid arthritis (RA) is influenced by accessibility to specialized care devices. We attempted to analyze the impact of their availability.

Methods

We analyzed time related to diagnosis delay measuring: (1) Time from first clinical symptoms to the first visit with the rheumatologist; (2) Time from referral to the first visit of rheumatology; (3) Time between first symptom until final diagnosis; (4) Time between first symptom until the initiation of the first disease-modifying antirheumatic drug (DMARD). The presence of these 6 rheumatology devices was defined: (1) Early arthritis monographic clinics, (2) RA monographic clinics, (3) mechanisms for fast programming, (4) algorithms for referral from primary care (PC), (5) rheumatology consultation services in PC and (6) consulting services in PC.

Results

The mean time from onset of symptoms to diagnosis or the establishment of a DMARD in RA patients in Catalonia is very long (11 months). Patients seen in rheumatology devices such as RA monographic clinics, rheumatology consultation in PC and specially in early arthritis clinics are treated early with DMARDs.

Conclusion

The existence of monographic clinics or consulting in primary care centers is essential to improve early care of RA patients.

Keywords:
Early onset rheumatoid arthritis
Health care devices
AUDIT study
Resumen
Objetivo

Analizar el retraso diagnóstico y terapéutico en pacientes con AR de reciente comienzo en 19 centros de Catalunya.

Métodos

Encuesta epidemiológica en 183 pacientes en que se cuantificaron los tiempos en relación con el retraso diagnostico midiendo: 1) aparición del primer síntoma hasta la primera visita a Reumatología; 2) desde la derivación hasta la primera visita de Reumatología; 3) entre aparición del primer síntoma hasta el diagnóstico, y 4) entre aparición del primer síntoma hasta el inicio del primer FAME. Se definió la existencia de 6 dispositivos asistenciales diferenciados.

Resultados

El tiempo medio desde el inicio de los síntomas hasta la instauración de un FAME en pacientes con AR en Catalunya es muy largo (11 meses). Pacientes atendidos en dispositivos como consultas de AR, consultas especializadas en atención primaria y sobre todo en consultas de artritis de inicio son tratados de manera más temprana con FAME.

Conclusión

La existencia de determinados dispositivos asistenciales es fundamental para mejorar la atención precoz en la AR.

Palabras clave:
Artritis reumatoide de inicio reciente
Dispositivos de asistenciales especializados
Estudio AUDIT

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