Diagnostic delay of more than 6 months contributes to poor radiographic and functional outcome in psoriatic arthritis
Diagnostic delay of more than 6 months contributes to poor radiographic and functional outcome in psoriatic arthritis
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DOI：
10.1136/annrheumdis-2013-204858
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发表时间：
2015-06-01
影响因子：
27.4
通讯作者：
FitzGerald, Oliver
中科院分区：
文献类型：
--
作者：
Haroon, Muhammad;Gallagher, Phil;FitzGerald, Oliver
目的(1)调查导致从症状出现到风湿病专家首次就诊延迟的人口学和临床特征；(2)比较那些在病程早期就去看风湿病医生的患者与那些后来才确诊的患者的临床、放射学和患者报告的结果。方法对所有符合CASPAR标准、平均病程在100 ~ 10年的银屑病关节炎（PsA）患者进行详细的临床评价。从症状发作到他们第一次风湿病遭遇的总滞后时间进行了研究。数据提取自转诊信和医疗记录。根据患者是否在症状发作后6个月内或以后就诊风湿病学家，将患者分为早期会诊者或晚期会诊者。结果283例PsA患者。该队列从发病到第一次风湿病评估的中位滞后时间为1.00年（IQR 0.5-2）。30% （n=86）、53% （n=149）和71% （n=202）的队列患者在症状出现后6个月、1年和2年内分别就诊于风湿病专家。受教育程度低（OR 2.09, p=0.02）和体质指数低（OR 0.92, p=0.01）的PsA患者诊断延迟的可能性更大。在多元逐步回归分析中，该模型预测晚期会诊者与周围关节糜烂的发展（OR 4.25, p=0.001）和较差的健康评估问卷得分（OR 2.2, p=0.004）有显著相关性。结论：即使从症状出现到风湿病学家首次就诊延迟6个月，也会导致周围关节糜烂的发展和长期身体功能的恶化。
Objectives (1) To investigate the demographic and clinical characteristics contributing to the delay from symptom onset to the first visit to a rheumatologist; (2) to compare clinical, radiographic and patient-reported outcome measures of those who saw a rheumatologist early in their disease course with those who were diagnosed later.Methods All psoriatic arthritis (PsA) patients, fulfilling CASPAR criteria, with an average disease duration of >10years were invited for detailed clinical evaluation. The total lag time from symptom onset to their first rheumatological encounter was studied. The data were extracted from the referral letters and medical records. Patients were classified as early consulters or late consulters depending on whether they were seen by a rheumatologist within or beyond 6months of symptom onset.Results 283 PsA patients were studied. Median lag time from the disease onset to the first rheumatological assessment of the cohort was 1.00years (IQR 0.5-2). 30% (n=86), 53% (n=149) and 71% (n=202) of the cohort were seen by a rheumatologist within 6months, 1 and 2years of symptom onset, respectively. PsA patients with low education status (OR 2.09, p=0.02) and Body Mass Index (OR 0.92, p=0.01) were significantly more likely to have a diagnostic delay of >2years. On multiple stepwise regression analysis, the model predicted significant association of late consulters with the development of peripheral joint erosions (OR 4.25, p=0.001) and worse Health Assessment Questionnaire scores (OR 2.2, p=0.004).Conclusions Even a 6-month delay from symptom onset to the first visit with a rheumatologist contributes to the development of peripheral joint erosions and worse long-term physical function.