Decreasing delays in the diagnosis and treatment of rheumatoid arthritis in Brazil: a nationwide multicenter observational study

• Published in: Advances in rheumatology (London, England) Vol. 63; no. 1; p. 3
• Main Authors: de Albuquerque, Cleandro Pires, Reis, Ana Paula Monteiro Gomides, Santos, Ana Beatriz Vargas, Bértolo, Manoel Barros, Júnior, Paulo Louzada, Giorgi, Rina Dalva Neubarth, Radominski, Sebastião Cezar, Resende Guimarães, Maria Fernanda B, Bonfiglioli, Karina Rossi, da Cunha Sauma, Maria de Fátima L, Pereira, Ivânio Alves, Brenol, Claiton Viegas, da Mota, Licia Maria Henrique, Santos-Neto, Leopoldo, Castelar Pinheiro, Geraldo R
• Format: Journal Article
• Language: English
• Published: England BioMed Central 06.02.2023; Sociedade Brasileira de Reumatologia; BMC
• Subjects: Adult; Arthritis, Rheumatoid - diagnosis; Arthritis, Rheumatoid - drug therapy; Brazil; Chi-square test; Confidence intervals; Diagnosis; Epidemiology; Female; Health care; Humans; Male; Medical diagnosis; Medical records; Middle Aged; Observational studies; Outcome and process assessment; Prospective Studies; Rheumatoid arthritis; Rheumatoid arthritis; RHEUMATOLOGY; Therapeutics; Trends; Variance analysis; Brazil; Health care; Epidemiology; Outcome and process assessment; Therapeutics; Rheumatoid arthritis; Rheumatoid arthritis
• ISSN: 2523-3106; 2523-3106
• DOI: 10.1186/s42358-022-00265-0

Management delays imply worse outcomes in rheumatoid arthritis (RA) and, therefore, should be minimized. We evaluated changes in diagnostic and treatment delays regarding RA in the last decades in Brazil. Adults fulfilling the ACR/EULAR (2010) criteria for RA were assessed. Delays in diagnosis and treatment, and the frequencies of early management initiation within thresholds (windows of opportunity) of 3, 6, and 12 months from symptoms onset were evaluated. The Mann-Kendall trend test, chi-squared tests with Cramer's V effect sizes and analysis of variance were conducted. We included 1116 patients: 89.4% female, 56.8% white, mean (SD) age 57.1 (11.5) years. A downward trend was found in diagnostic (tau = - 0.677, p < 0.001) and treatment (tau = - 0.695, p < 0.001) delays from 1990 to 2015. The frequency of early management increased throughout the period, with ascending effect sizes across the 3-, 6-, and 12-month windows (V = 0.120, 0.200 and 0.261, respectively). Despite all improvements, even in recent years (2011-2015) the diagnostic and treatment delays still remained unacceptably high [median (IQR): 8 (4-12) and 11 (5-17) months, respectively], with only 17.2% of the patients treated within the shortest, 3-month window. The delays in diagnosis and treatment of RA decreased during the last decades in Brazil. Improvements (effect sizes) were greater at eliminating extreme delays (≥ 12 months) than in attaining really short management windows (≤ 3 months). Very early treatment was still an unrealistic goal for most patients with RA.