THE LAG TIME BETWEEN ONSET OF SYMPTOMS AND DIAGNOSIS OF RHEUMATOID-ARTHRITIS

Objective. Rheumatoid arthritis (RA) may be biologically reversible if treated in the first several months, yet it is unknown whether patien ts are diagnosed that early. We investigated the lag time between symp tom onset and diagnosis of RA in a population with excellent access to rheumatology care. Methods. Using review of medical records, we evalu ated all patients newly diagnosed as having RA from 1987 through 1990, at a health maintenance organ organization in central Massachusetts. Total lag time from symptom onset to first definite diagnosis was divi ded into medical encounter lag time (from symptom onset to first medic al encounter) and diagnosis lag time (from first medical encounter to diagnosis). Results. The median total lag time was 36 weeks (range 4 w eeks to >10 years). The median medical encounter lag time was 4 weeks (not all patients included in the analysis). The median diagnosis lag time was 18 weeks. Diagnosis lag time was shorter for patients with pr ogressive disease and positive rheumatoid factor on the initial test. Of 25 patients with symmetric arthritis and positive rheumatoid factor , only 5 (20%) were diagnosed within 2 months, and 10 (40%) were diagn osed more than 6 months after symptom onset. Conclusion. RA diagnosis is usually delayed for several months after symptoms begin, in large p art because of delay in diagnosis by the physician. Thus, the goal of initiating treatment extremely early may be unrealistic for most patie nts.