POS1413 INTERVAL BETWEEN SYMPTOM ONSET AND DIAGNOSIS AMONG PATIENTS WITH AUTOIMMUNE RHEUMATIC DISEASES IN A MULTI-ETHNIC ASIAN POPULATION
Authors: L. Xiang, A. Low, Y. Y. Leung, W. Fong, M. Gandhi, S. Yoon, T. C. Lau, D. R. Koh, J. Thumboo
Journal: Annals of the Rheumatic Diseases (2021)

Background: The interval between symptom onset and diagnosis can often be longer than is ideal in autoimmune rheumatic diseases (ARDs). Objectives: We aimed to characterise this interval among patients newly diagnosed with ARDs in a multi-ethnic Asian population and to identify factors associated with a longer interval. Methods: We used Scott’s model of pathways to treatment to characterise the interval between symptom onset and diagnosis into 4 intervals: #1 between symptom onset and first seeking medical attention, #2 between first medical attention and rheumatology referral, #3 between rheumatology referral and first rheumatology assessment, and #4 between first rheumatology assessment and diagnosis. Linear regression models were used to identify factors associated with a longer the overall interval between symptom onset and diagnosis and Interval #1. Results: Among 259 patients (age: 51±15 years, female: 71%, most common three ARDs: rheumatoid arthritis (n = 75), axial spondyloarthritis (n = 40) and psoriatic arthritis (n = 35)), the median overall interval was 11.5 months. Interval #1 (median = 4.9 months) was significantly longer than the other intervals (Table 1). Patients with axial spondyloarthritis had a significantly longer overall interval (median = 38.7 months) and Interval #1 (median = 26.6 months) compared to patients with RA (median = 7.6 and 3.5 months, respectively), PsA (median = 7.0 and 2.6 months, respectively) and the other ARDs. Gender was the only patient-related factor significantly associated with the overall interval (reference = male, coefficient = -15.3, p = 0.033) in regression models. Conclusion: A longer than ideal interval between symptom onset and diagnosis was observed among patients with ARDs. This was primarily due to a relatively long interval between symptom onset and first seeking medical attention, and highlights the importance of interventions targeting patients prior to first medical attention in reducing the duration between symptom onset and diagnosis. References: [1]Scott SE, Walter FM, Webster A, Sutton S, Emery J. The model of pathways to treatment: conceptualization and integration with existing theory. Br J Health Psychol. 2013;18(1):45-65. Table 1. Interval between symptom onset and diagnosis Overall interval, months, median (lower and upper quartiles)† Interval #1, months, median (lower and upper quartiles) Interval #2, months, median (lower and upper quartiles) Interval #3, months, median (lower and upper quartiles) Interval #4, months, median (lower and upper quartiles) Overall (n = 259) 11.5 (4.7 – 36.0) 4.9 (1.0 – 24.0) 0.3 (0.0 – 3.9) 1.5 (0.8 – 1.8) 0.0 (0.0 – 1.2) RA (n = 75) 7.6 (3.1 – 14.8) 3.5 (1.3 – 11.6) 0.2 (0.0 – 2.5) 1.3 (0.6 – 1.6) 0.0 (0.0 – 0.2) AxSpA (n = 40) 38.7 (9.6 – 66.7) 26.6 (4.2 – 56.1) 1.6 (0.0 – 7.6) 1.6 (1.2 – 2.3) 0.0 (0.0 – 2.0) PsA (n = 35) 7.0 (3.0 – 28.4) 2.6 (0.2 – 11.3) 0.5 (0.2 – 3.9) 1.6 (0.6 – 1.7) 0.0 (0.0 – 0.0) Seronegative IA (n = 21) 12.0 (4.7 – 22.8) 6.4 (1.9 – 34.4) 0.1 (0.0 – 4.6) 1.4 (1.3 – 1.5) 0.0 (0.0 – 0.8) SjS (n = 27) 14.2 (6.0 – 48.0) 4.6 (0.6 – 19.0) 0.3 (0.0 – 3.9) 1.6 (0.9 – 1.9) 0.8 (0.0 – 2.3) UCTD (n = 27) 15.7 (5.1 – 39.8) 2.2 (0.7 – 24.0) 0.8 (0.1 – 8.1) 1.6 (0.5 – 1.8) 1.2 (0.0 – 2.1) Other ARDs (n = 34) 8.1 (5.3 – 36.0) 6.3 (0.9 – 31.7) 0.2 (0.0 – 1.1) 1.5 (1.2 – 1.8) 0.3 (0.0 – 1.1) Overall interval and Intervals #1-4: refer to abstract for definitions; RA: rheumatoid arthritis; axSpA: axial spondyloarthritis; PsA: psoriatic arthritis; IA: inflammatory arthritis; SjS: Sjögren’s syndrome; UCTD: undifferentiated connective tissue disease; other ARDs: systemic lupus erythematosus, systemic sclerosis, idiopathic inflammatory myopathies, palindromic rheumatism and overlap syndromes. †Intervals #1-4 did not sum to the overall interval mainly due to the fact that Intervals #1-4 might not available for all patients. Disclosure of Interests: None declared