Diagnostic and therapeutic delay in Rheumatoid Arthritis patients: Impact on disease outcome

  • Faiza Naeem RHEUMATOLOGY
  • Saira Elaine Anwer khan RHEUMATOLOGY
  • Muhammad Ahmed Saeed
  • Sumaira Farman RHEUMATOLOGY
Keywords: DAS28, Diagnostic delay, HAQ-DI, Rheumatoid arthritis, Therapeutic delay


Objective: To identify factors causing diagnostic and therapeutic delay in patients with rheumatoid arthritis, and to evaluate relationship of diagnostic and therapeutic delay with disease outcome.

Methods: This cross-sectional study was conducted in Rheumatology Department, Fatima Memorial Hospital, Lahore, Pakistan, from May 2018 to July 2018. In this study 102 patients fulfilling ACR/EULAR criteria 2010 were enrolled. Lag times were calculated in months: lag-1 (delay in initial medical consultation); lag-2 (delay in consulting rheumatologists); lag-3 (diagnostic delay); lag-4 (therapeutic delay). Disease activity and functional outcome were measured by DAS28, HAQ-DI respectively. Association of lag-3 and lag-4 with HAQ-DI and DAS28 was calculated by Pearson correlation.

Results: Median (IQR) disease duration of study group was 6(2-10) years. Initial consultations were with; orthopedic surgeon 40(39.2%), general practitioner 27(26.5%), rheumatologist 13(12.7%), medical specialists 14(13.7%). Median (IQR) lag times in months: lag-1 (delayed initial consultation): 2(0-5), lag-2 (delay in consulting rheumatologist): 30(7.7-72), lag-3 (diagnostic delay): 12(3-48), lag-4 (therapeutic delay):18(5.7-72). Factors attributed to lag-3 (diagnostic delay) and lag-4 (therapeutic delay) (p<0.05): older Age (r= 0.2), education level (r= - 0.2), initial consultation (non-rheumatologist) (r=0.2), lag-2(r=0.8), >three doctors visited before diagnosis(r=0.6). Positive anti-CCP antibodies(r=0.2) and lag-1 (delayed initial consultation) (r=1) were associated with lag-3 (diagnostic delay) only; no association was found with positive RA factor. Significant correlation (p=<0.05) of lag-3 (diagnostic delay) was found with both DAS28(r=0.2) & HAQ-DI(r=0.2). Similarly lag-4 (therapeutic delay) also correlated with both & DAS28(r=0.2) & HAQ-DI(r=0.3) (p=<0.05).

Conclusion: Diagnostic and therapeutic delay were associated with older age, lower education and delayed consultation with rheumatologist but not with positive RA factor. Positive anti-CCP antibodies were associated with diagnostic delay only. Diagnostic and therapeutic delay led to high disease activity and poor functional outcome in RA patients.

doi: https://doi.org/10.12669/pjms.37.4.3471

How to cite this:
Naeem F, Khan SEA, Saeed MA, Farman S. Diagnostic and therapeutic delay in Rheumatoid Arthritis patients: Impact on disease outcome. Pak J Med Sci. 2021;37(4):1001-1007. doi: https://doi.org/10.12669/pjms.37.4.3471

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Author Biographies

Saira Elaine Anwer khan, RHEUMATOLOGY

Saira E.A Khan

MRCP (UK), SCE Rheumatology (UK)

Assistant Professor, Division of rheumatology

Fatima Memorial Hospital, Lahore, Pakistan


Muhammad Ahmed Saeed

FCPS Rheumatology, FACR, FCPS Internal Medicine

Associate Professor 

Al-Aleem Medical College, Lahore 

Head Department of Rheumatology, Gulab Devi Teaching Hospital

Consultant Rheumatologist, National Hospital and Medical Center, Lahore


Sumaira Farman, RHEUMATOLOGY

Sumaira Farman

 FRCP, FACP, FACR, SCE Rheumatology (UK)

Graduate certificate Paediatric Rheumatology (Australia)

Professor, Division of rheumatology, FMH

Consultant Rheumatologist, National Hospital and Medical Center, Lahore


How to Cite
Naeem, F., Anwer khan, S., Saeed, M., & Farman, S. (2021). Diagnostic and therapeutic delay in Rheumatoid Arthritis patients: Impact on disease outcome. Pakistan Journal of Medical Sciences, 37(4). https://doi.org/10.12669/pjms.37.4.3471
Original Articles