AB0255 Delay in Diagnosis from Onset of Symptoms by More than One Year in 48% of 177 Patients with Rheumatic Diseases, Including 36% in Patients with Rheumatoid Arthritis in Australia

Background Delayed diagnosis is recognized in many rheumatic diseases. Early treatment is regarded as critical for optimal clinical outcomes in patients with inflammatory rheumatic diseases. We studied possible delay in diagnosis in a usual care setting in 2013 using a simple 1-page form completed by the rheumatologist. Objectives To analyze patients seen in a teaching hospital rheumatology clinic for year of onset of symptoms and year of diagnosis and onset of treatment, using a standardized form for rheumatologists (RHEUMDOC). Methods All patients seen in one setting were evaluated according to a multidimensional health assessment questionnaire (MDHAQ) completed by the patient, and by a complementary doctor form (RHEUMDOC) completed by the physician. RHEUMDOC includes entry of 3 possible rheumatic diagnoses queried for year of onset of symptoms and year of diagnosis. For this study, patients were classified into 4 groups according to diagnosis: rheumatoid arthritis (RA), osteoarthritis (OA), other inflammatory diseases (INF), and other non-inflammatory diseases (NON); differences between groups were compared using Wilcoxon rank sum tests. Results Among 177 patients seen between February and October 2013, the mean interval from year of symptom onset to year of diagnosis was 3.7 years, 1.4 years in RA, 4.9 years in OA, and 4.6 years in other INF and other NON inflammatory diseases. Among all patients, 91 (51%) had a diagnosis within one year, including 64% with RA, 36% with OA, 49% with other INF, and 50% with other NON. The delay in RA was significantly less than in OA (p=0.004), other INF (p=0.027) and all non-RA (p=0.006). Nonetheless, 28% of RA patients received a diagnosis 1-5 years, and 8% >5 years, after symptom onset. Diagnosis Number of patients Mean (SD) # years from symptoms to diagnosis Number of patients in each group according to interval from onset of symptoms to diagnosis 5 years n (%) n (%) n (%) RA 53 1.4 (3.3) 34 (64%) 15 (28%) 4 (8%) OA 33 4.9 (7.8) 12 (36%) 12 (36%) 9 (27%) Other INF 73 4.6 (7.6) 36 (49%) 18 (25%) 19 (26%) Other Non-INF 18 4.6 (9.4) 9 (50%) 5 (26%) 4 (22%) Total 177 3.7 (7.0) 91 (51%) 50 (28%) 36 (20%) Conclusions A considerable delay from onset of symptoms to definitive diagnosis remains an important problem in rheumatic diseases. Delay in diagnosis is more common in patients with diseases other than RA, but remains in more than 1/3 of RA patients. Identification of specific contributors to this del