POS0879 EXPLORING DIAGNOSTIC TIMELINES: A CROSS-SECTIONAL STUDY OF REFERRAL AND DIAGNOSTIC DELAYS OF PATIENTS WITH CHRONIC INFLAMMATORY RHEUMATIC DISEASES
Authors: N. Ziade, N. A. Al-Ani, A. Maroof, A. Ridha Adnan, M. EL Rakaawi, C. Haouichet, B. Elzorkany, S. Gamal, M. Erraoui, M. Mashaleh, F. Alnaimat, B. Masri, F. Baron, L. El Kibbi, K. Aouad, K. Mechleb, I. Hmamouchi
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> Referral delay of patients with chronic inflammatory rheumatic diseases (CIRDs) to rheumatologists is one of the major obstacles to benefiting from the window of opportunity during the early disease phases. Timelines in Arab countries are poorly studied. Yet, differences in the healthcare systems and cultural backgrounds might drive referral patterns. <h3>Objectives:</h3> To evaluate the proportion of patients with CIRDs among all new referrals in 8 Arab countries. In addition, we estimated the diagnostic delay in new patients referred with CIRDs and assessed its associated factors. <h3>Methods:</h3> Sixteen rheumatologists from 8 Arab countries provided their outpatient practice data about the new patients diagnosed with rheumatoid arthritis (RA), axial spondyloarthritis (axSpA) and psoriatic arthritis (PsA) and peripheral forms of SpA (pSpA, inflammatory bowel diseases associated Spa, reactive arthritis), as well as the number of all patients seen in their practice to serve as denominators. In addition, data about the consecutive new patients with CIRDs were collected: demographics, time periods between the first symptom on one hand, first consultation with any physician, with a rheumatologist, and CIRD diagnosis on the other hand. Also, disease characteristics and practice settings were collected. Data was presented descriptively (median time delay and interquartile range (IQR)), and factors associated with diagnostic delay were identified using a multivariable linear regression. <h3>Results:</h3> In a sample of 2490 patients seen in November 2023, 746 (30%) were new patients; of those, 124 (17%) were diagnosed with RA, 94 (13%) with axSpA, and 16 (2%) with PsA (in total, 9.4% of all patients). The proportion of new patients and those with CIRDs varied between the countries (10-62% and 7-73%, respectively). In addition, 393 files of consecutive newly referred patients with CIRDs in 2023 were reviewed, 183 RA (47%), 118 (30%) PsA and peripheral forms of SpA, and 92 (23%) axSpA. Their mean age was 44±15 years; 257 (65%) were females, 164 (42%) had a university education, and 201 (51%) were seen in a private setting. The median time (IQR) in months between the initial symptom on one hand and the first consultation with any physician was 0.9 (0-12), any rheumatologist 14 (4-40), current rheumatologist 28 (10-78), and diagnosis 18 (6-49) (Figure 1). The current rheumatologists initiated a DMARD in 192 cases (49%), which was mostly a conventional synthetic DMARD (150 (38%)) followed by a biological DMARD in 89 (23%). In the opinion of the rheumatologist, 304 (77%) patients were delayed, and the most reasons were related to the primary care physician (PCP) in 188 (48%) and to the patient in 154 (39%). Factors associated with diagnostic delay in the multivariable analysis were seeing the patient in a public setting (p=0.0048), and delay from the time of the first symptom to any physician (p&lt;0.001) and to any rheumatologist consultation (p&lt;0.001). <h3>Conclusion:</h3> The proportion of new patients diagnosed with CIRDs among all outpatient consultations was 9.4% and varied across countries. This study highlights a significant median delay of 18 months between the onset of initial symptoms and the diagnosis of patients with CIRDs. This was primarily due to the delay in referrals from the PCP to the rheumatologist and was associated with the public consultation setting and delay in seeking medical advice. Addressing these patterns will help shape the future implementation of referral strategies for patients with CIRDs to rheumatology. <h3>REFERENCES:</h3> <b>NIL.</b> <h3>Acknowledgements:</h3> <b>NIL.</b> <h3>Disclosure of Interests:</h3> <b>None declared.</b>