Delayed diagnosis and treatment of rheumatoid arthritis in Sarawak General Hospital
Introduction: Rheumatoid arthritis (RA) is an autoimmune systemic inflammatory disorder characterised by symmetrical polyarthritis which leads to damage of joints if untreated. Early diagnosis and treatment of RA to achieve tight control of the disease will improve outcome and prevent disabilit...
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| Main Authors: | , , , |
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| Format: | Article |
| Language: | en |
| Published: |
Malaysian Medical Association
2020
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| Subjects: | |
| Online Access: | http://ir.unimas.my/id/eprint/49810/1/Delayed%20diagnosis.pdf http://ir.unimas.my/id/eprint/49810/ https://www.e-mjm.org/2020/v75n2/rheumatoid-arthritis.pdf |
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| Summary: | Introduction: Rheumatoid arthritis (RA) is an autoimmune
systemic inflammatory disorder characterised by
symmetrical polyarthritis which leads to damage of joints if
untreated. Early diagnosis and treatment of RA to achieve
tight control of the disease will improve outcome and
prevent disability.
Objective: We aimed to examine the delays in the diagnosis
of RA in patients presenting to the Rheumatology Unit,
Sarawak General Hospital (SGH).
Methods: Data on demographics and various delays were
collected from the medical records from January 2015 until
March 2018. Patient delay is defined as from the time onset
of symptom to the first primary care presentation. Primary
care delay is defined as from the first primary care
presentation to referral to rheumatology. Rheumatology
delay is defined as from rheumatology referral to
appointment at the rheumatology clinic. Disease modifying
anti-rheumatic drugs (DMARDS) delay is defined as from the
rheumatology clinic appointment to starting DMARDS. Total
delay is from symptom onset to starting DMARDS.
Results: There were 84 new patients diagnosed with
rheumatoid arthritis, out of which 66 were females (78.6%).
The mean age was 54.1±12.0 years. Only 19 patients (22.6%)
were treated with DMARDS within 12 weeks of symptom
onset. The median time for patient delay was four weeks
(Interquartile range (IQR) 2-20 weeks), while the median time primary care delay was 11 weeks (IQR 4-24 weeks). The
median time for rheumatology delay was zero weeks (IQR 0-
1 week) and the DMARDS delay was zero week (IQR 0). The
median time from symptom onset to DMARDS initiation was
23.5 weeks (IQR 13.25-51 weeks). |
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