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.1 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.2,3 Patients treated early (during the first three months since disease onset) have a better prognosis and may go into disease remission.

Studies performed to evaluate time between disease onset and time of diagnosis and start of adequate treatment are scarce4–9 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.

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.

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.

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,4 Spain,5 Canada,9 the United Kingdom,8 the Middle East,6 and in European countries,7 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.7,9,10 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.