Letter to the Editor
The Lag Time Between Onset of Symptoms, Medical Encounter, and Initiation of Disease Modifying Antirheumatic Drugs in Patients With Rheumatoid Arthritis
Tiempo entre comienzo de síntomas, acudir al médico e inicio de fármacos modificadores de la enfermedad en pacientes con artritis reumatoide
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"documento" => "simple-article" "crossmark" => 0 "subdocumento" => "cor" "cita" => "Reumatol Clin. 2014;10:130-1" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 3531 "formatos" => array:3 [ "EPUB" => 59 "HTML" => 3168 "PDF" => 304 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Jaccoud's Arthropathy Associated With Reynolds Syndrome" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "130" "paginaFinal" => "131" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Artropatía de Jaccoud asociada a síndrome de Reynolds" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 460 "Ancho" => 1301 "Tamanyo" => 109161 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Jaccoud arthropathy on the hands, with ulnar deviation of the MCP, ‘gooseneck’ deformity and ‘Z’ thumb deviation with these deformities being more pronounced on the right hand (A). X-ray of the hands in which, in addition to the abovementioned deformities we find juxtaarticular osteopenia, chondrocalcinosis of the right carpus and absence of erosions or degenerative signs (B).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Walter Alberto Sifuentes Giraldo, Marta Grandal Platero, Carlos de la Puente Bujidos" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Walter Alberto" "apellidos" => "Sifuentes Giraldo" ] 1 => array:2 [ "nombre" => "Marta" "apellidos" => "Grandal Platero" ] 2 => array:2 [ "nombre" => "Carlos" "apellidos" => "de la Puente Bujidos" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S1699258X13001514" "doi" => "10.1016/j.reuma.2013.07.004" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1699258X13001514?idApp=UINPBA00004M" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574313001512?idApp=UINPBA00004M" "url" => "/21735743/0000001000000002/v2_201403290120/S2173574313001512/v2_201403290120/en/main.assets" ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "The Lag Time Between Onset of Symptoms, Medical Encounter, and Initiation of Disease Modifying Antirheumatic Drugs in Patients With Rheumatoid Arthritis" "tieneTextoCompleto" => true "saludo" => "To the Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "131" "paginaFinal" => "132" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Abraham Zonana Nacach, Alfredo Campaña-Parra, Jesús Ernesto Santana-Sahagún" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Abraham" "apellidos" => "Zonana Nacach" "email" => array:1 [ 0 => "zonanaa@yahoo.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Alfredo" "apellidos" => "Campaña-Parra" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Jesús Ernesto" "apellidos" => "Santana-Sahagún" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Unidad de Investigación Clínica y Epidemiología, Hospital General Regional N.° 20, Instituto Mexicano del Seguro Social, Tijuana, Baja California, Mexico" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Consulta externa Reumatología, Hospital General Regional N.° 20, Instituto Mexicano del Seguro Social, Tijuana, Baja California, Mexico" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Tiempo entre comienzo de síntomas, acudir al médico e inicio de fármacos modificadores de la enfermedad en pacientes con artritis reumatoide" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Rheumatoid arthritis (RA) is an autoimmune disease and most patients have a chronic, fluctuating progression. If untreated, it leads to progressive joint deformity, disability and premature death. The onset of early treatment with disease modifying drugs (DMARD) reduces disability at 5 years.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The objective of treatment in patients with recent onset RA is the suppression of disease activity before joint damage is established; this justifies the importance of opportune therapeutic intervention.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3</span></a> Patients treated early (during the first three months since disease onset) have a better prognosis and may go into disease remission.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Studies performed to evaluate time between disease onset and time of diagnosis and start of adequate treatment are scarce<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4–9</span></a> and none exist in Mexico. The objective of the study was to evaluate the time since the beginning of disease and the visit to the family physician, the time since this and the referral to the rheumatologist and the time to onset of DMARD treatment.</p><p id="par0015" class="elsevierStylePara elsevierViewall">We included, from January to December 2010, adult patients with clinical manifestations of RA and no previous evaluation by a rheumatologist or DMARD treatment. Patients were sent to different family physicians or from the internal medicine specialist to the rheumatologist of a regional General Hospital of the Instituto Mexicano Seguro Social (IMSS). We defined RA based on the 1987 criteria proposed by the American College of Rheumatology. We evaluated the following timelines: time from onset of symptoms to the visit to the family physician; time from disease onset to the first visit to the rheumatologist and time since disease onset and DMARD treatment onset.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Mean age±SD of the 98 patients was 38±9 years; 85% were female; 49 had an RA disease progression of 1–6 months, the diagnosis established by the family physician was RA in 79% of patients and the mean number±SD of visits the patient received before referral to rheumatology was 6.6±5.8). In 19, 33, 23 and 24% of patients, the onset of DMARD treatment was 1–3, 4–6, 7–12 and ≥13 months after RA symptom onset, respectively. The mean time for the patient to receive medical attention was 2.9 months, and for referral to Rheumatology from primary care was 6.6 months. For DMARD treatment onset it was 9.9 months.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Our results show that only in 19% of patients was DMARD started in the first three months after disease onset and the delay in the prescription of DMARD was mainly due to the delay in referral from family medicine to the rheumatologist. Studies performed in the past 2 decades which evaluate the onset of DMARD treatment in patients with early RA, performed in the US,<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Spain,<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Canada,<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> the United Kingdom,<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> the Middle East,<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> and in European countries,<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> show that the mean time since the onset of disease and the onset of DMARD treatment ranges from 6 to 18 months, similar to our findings (mean 11 months). This indicates that the diagnosis of RA after the onset of symptoms is delayed and, therefore, the objective of starting treatment early is not achieved in most cases. Less than 30% of RA patients receive DMARD treatment in the first 3 months.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7,9,10</span></a> It is necessary to implement measures that act on early diagnosis and treatment of RA, through the diffusion of knowledge relating to the disease in the general population, advertising campaigns as well as an increase in the level of knowledge regarding RA in primary care physicians.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Zonana Nacach A, Campaña-Parra A, Santana-Sahagún JE. Tiempo entre comienzo de síntomas, acudir al médico e inicio de fármacos modificadores de la enfermedad en pacientes con artritis reumatoide. Reumatol Clin. 2014;10:131–132.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Reduced disability at five years with early treatment of inflammatory polyarthritis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "N.J. Wiles" 1 => "M. Lunt" 2 => "M.E. Barret" 3 => "M. Bukhari" 4 => "J.A. Silman" 5 => "P.M. 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Grindulis" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rheumatology (Oxford)" "fecha" => "2007" "volumen" => "46" "paginaInicial" => "1438" "paginaFinal" => "1440" ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Time to treatment for new patients with rheumatoid arthritis in a major metropolitan city" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "S. Jamal" 1 => "S.M. Alibhai" 2 => "E.M. Badley" 3 => "C. 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Huizinga" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/art.27692" "Revista" => array:6 [ "tituloSerie" => "Arthritis Rheum" "fecha" => "2010" "volumen" => "62" "paginaInicial" => "3537" "paginaFinal" => "3546" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20722031" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735743/0000001000000002/v2_201403290120/S2173574314000136/v2_201403290120/en/main.assets" "Apartado" => array:4 [ "identificador" => "8400" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735743/0000001000000002/v2_201403290120/S2173574314000136/v2_201403290120/en/main.pdf?idApp=UINPBA00004M&text.app=https://reumatologiaclinica.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574314000136?idApp=UINPBA00004M" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 11 | 15 | 26 |
| 2024 October | 44 | 26 | 70 |
| 2024 September | 37 | 21 | 58 |
| 2024 August | 80 | 45 | 125 |
| 2024 July | 54 | 42 | 96 |
| 2024 June | 58 | 35 | 93 |
| 2024 May | 66 | 27 | 93 |
| 2024 April | 50 | 30 | 80 |
| 2024 March | 69 | 35 | 104 |
| 2024 February | 65 | 38 | 103 |
| 2024 January | 41 | 27 | 68 |
| 2023 December | 46 | 38 | 84 |
| 2023 November | 50 | 27 | 77 |
| 2023 October | 46 | 39 | 85 |
| 2023 September | 119 | 35 | 154 |
| 2023 August | 54 | 30 | 84 |
| 2023 July | 45 | 37 | 82 |
| 2023 June | 46 | 23 | 69 |
| 2023 May | 57 | 28 | 85 |
| 2023 April | 35 | 6 | 41 |
| 2023 March | 51 | 30 | 81 |
| 2023 February | 53 | 20 | 73 |
| 2023 January | 51 | 26 | 77 |
| 2022 December | 80 | 29 | 109 |
| 2022 November | 60 | 26 | 86 |
| 2022 October | 72 | 36 | 108 |
| 2022 September | 63 | 30 | 93 |
| 2022 August | 58 | 42 | 100 |
| 2022 July | 39 | 33 | 72 |
| 2022 June | 50 | 38 | 88 |
| 2022 May | 35 | 27 | 62 |
| 2022 April | 58 | 48 | 106 |
| 2022 March | 43 | 48 | 91 |
| 2022 February | 55 | 40 | 95 |
| 2022 January | 50 | 31 | 81 |
| 2021 December | 45 | 46 | 91 |
| 2021 November | 45 | 43 | 88 |
| 2021 October | 51 | 54 | 105 |
| 2021 September | 60 | 37 | 97 |
| 2021 August | 43 | 40 | 83 |
| 2021 July | 42 | 39 | 81 |
| 2021 June | 72 | 34 | 106 |
| 2021 May | 74 | 37 | 111 |
| 2021 April | 107 | 54 | 161 |
| 2021 March | 77 | 26 | 103 |
| 2021 February | 42 | 23 | 65 |
| 2021 January | 45 | 25 | 70 |
| 2020 December | 39 | 22 | 61 |
| 2020 November | 31 | 23 | 54 |
| 2020 October | 25 | 13 | 38 |
| 2020 September | 43 | 22 | 65 |
| 2020 August | 38 | 19 | 57 |
| 2020 July | 27 | 32 | 59 |
| 2020 June | 40 | 39 | 79 |
| 2020 May | 36 | 17 | 53 |
| 2020 April | 25 | 28 | 53 |
| 2020 March | 12 | 10 | 22 |
| 2019 September | 2 | 0 | 2 |
| 2019 February | 2 | 0 | 2 |
| 2018 May | 4 | 1 | 5 |
| 2018 April | 41 | 10 | 51 |
| 2018 March | 38 | 7 | 45 |
| 2018 February | 31 | 5 | 36 |
| 2018 January | 19 | 8 | 27 |
| 2017 December | 34 | 5 | 39 |
| 2017 November | 33 | 5 | 38 |
| 2017 October | 27 | 4 | 31 |
| 2017 September | 39 | 2 | 41 |
| 2017 August | 48 | 7 | 55 |
| 2017 July | 49 | 11 | 60 |
| 2017 June | 73 | 8 | 81 |
| 2017 May | 84 | 11 | 95 |
| 2017 April | 55 | 8 | 63 |
| 2017 March | 63 | 6 | 69 |
| 2017 February | 24 | 3 | 27 |
| 2017 January | 33 | 6 | 39 |
| 2016 December | 64 | 13 | 77 |
| 2016 November | 53 | 3 | 56 |
| 2016 October | 90 | 12 | 102 |
| 2016 September | 71 | 8 | 79 |
| 2016 August | 64 | 2 | 66 |
| 2016 July | 40 | 7 | 47 |
| 2016 March | 1 | 0 | 1 |
| 2015 December | 2 | 0 | 2 |
| 2015 September | 1 | 0 | 1 |
| 2015 August | 1 | 0 | 1 |
| 2015 July | 25 | 6 | 31 |
| 2015 June | 36 | 6 | 42 |
| 2015 May | 47 | 8 | 55 |
| 2015 April | 39 | 11 | 50 |
| 2015 March | 35 | 8 | 43 |
| 2015 February | 54 | 5 | 59 |
| 2015 January | 59 | 8 | 67 |
| 2014 December | 41 | 11 | 52 |
| 2014 November | 33 | 8 | 41 |
| 2014 October | 36 | 11 | 47 |
| 2014 September | 33 | 14 | 47 |
| 2014 August | 40 | 16 | 56 |
| 2014 July | 41 | 19 | 60 |
| 2014 June | 42 | 13 | 55 |
| 2014 May | 39 | 12 | 51 |
| 2014 April | 53 | 20 | 73 |
| 2014 March | 42 | 15 | 57 |
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