Impact of Disease Duration and Onset Pattern on Treatment Delays and Progression of Rheumatoid Arthritis: Insights From a Pakistani Cohort.

Abstract

Introduction: Early diagnosis of rheumatoid arthritis (RA) is crucial to prevent joint damage and improve treatment outcomes. RA cases that are not polyarticular at onset, and/or are not beginning in the hand joints may face diagnostic delays, because of more convincing alternate diagnoses. This study examines the prevalence of onset pattern and location and its impact on diagnostic timing and disease progression in RA.

Methods: This prospective cross-sectional study was conducted at Sandeman Provincial Hospital Quetta, Pakistan (January-December 2022). Adults aged 17 years & above with RA meeting ACR criteria 2010 were included using a consecutive sampling technique. The associations were measured by Chi-squared and Cramer's V test. Bivariate and multinominal Regression models were used to analyse the duration and pattern of disease, delay in diagnosis and location of onset.

Results: Twelve hundred RA patients (966, 82.8% female) with a median age of 42 (IQR: 33-55), and a median disease duration of 5 years (IQR: 2-8), both positively skewed, were included in the study. At-least 408 (34%) patients had non-polyarticular onset at initial presentation, and around 458 (38%) patients had the onset on illness not beginning in the small joints of hands. Non-hand onset was significantly associated with age of onset, being 2.5 times higher in juvenile onset than in adult onset (OR = 2.515, p = 0.035). A diagnostic delay of 17.8 ± 27.9 months was found in the cohort, correlating significantly with total duration of disease (p < 0.01), pattern of disease (polyarticular vs. non polyarticular, p < 0.050) and with female gender (p = 0.014) but not with area of onset.

Conclusions: RA onset outside the hands with non-polyarticular patterns accounts for nearly one-third of cases, emphasising the need for a more easily accessible rheumatology care to reduce delays and mitigate prolonged disease impact.