ABSTRACT
Objective To identify the factors which lead to delay in diagnosis and initiation of disease-modifying anti-rheumatic drugs (DMARDs) in rheumatoid arthritis (RA) patients and their impact on disease outcome and functional ability. Methodology This cross-sectional study was conducted from June 2021 to May 2022 at the Department of Rheumatology and Immunology, Sheikh Zayed Hospital, Lahore. Inclusion criteria were patients aged >18 years who were diagnosed with RA, based on American College of Rheumatology (ACR) criteria 2010. Delay was defined as any sort of delay which leads to delay in diagnosis or initiation of treatment of more than three months. The factors and impact on disease outcome were measured by using Disease Activity Score-28 (DAS-28) for disease activity and Health Assessment Questionnaire-Disability Index (HAQ-DI) for functional disability. The collected data were analyzed with Statistical Package for Social Sciences (SPSS) version 24 (IBM Corp., Armonk, NY, USA). Results One hundred and twenty patients were included in the study. Mean delay in referral to a rheumatologist was 36.75±61.07 weeks. Fifty-eight (48.3%) patients with RA were misdiagnosed before presentation to a rheumatologist. Sixty-six (55%) patients had the perception that RA is a non-treatable disease. Delay in diagnosis of RA from onset of symptoms (lag 3) and delay in start of DMARDs from onset of symptoms (lag 4) were significantly associated with increased DAS-28 and HAQ-DI scores (p-value 0.001). Conclusion The factors which led to diagnostic and therapeutic delay were delayed consultation with a rheumatologist, old age, low education status and low socioeconomic status. Rheumatoid factor (RF) and anti-cyclic citrullinated peptide (anti-CCP) antibodies had no role in diagnostic and therapeutic delay. Many RA patients were misdiagnosed with gouty arthritis and undifferentiated arthritis before consulting a rheumatologist. This diagnostic and therapeutic delay compromises RA management leading to high DAS-28 and HAQ-DI in RA patients.
ABSTRACT
OBJECTIVE: To determine the frequency of metabolic syndrome in rheumatoid arthritis patients and its association with different factors i.e., age, gender, disease duration and treatment. METHODS: The cross-sectional study was conducted at Shaikh Zayed Hospital, Lahore, from July 2014 to June 2015, and comprised consecutive rheumatoid arthritis of either gender between the ages of 20 and 60 years. Frequency of metabolic syndrome was assessed by the National Education Cholesterol Programme 2004. SPSS 22 was used to compare the frequency of the syndrome among different treatment, age and gender groups. RESULTS: Of the 384 patients, 287(74.7%) were females, and 97(25.3%) were males with an overall mean age of 43.8±10.6 years (range: 20-60 years). Overall, 173(45.0%) patients were in >45years of age, and metabolic syndrome was found in 120 (31.3%). A negative association with metabolic syndrome was found when compared with treatment group of methotrexate alone and methotrexate in combination (p>0.05). CONCLUSIONS: Metabolic syndrome, an important risk factor for cardiovascular diseases, was more prevalent in rheumatoid arthritis patients.
