OBJECTIVE:The aim of this study was to evaluate referral and treatment delays by ethnicity/race in patients with rheumatoid arthritis (RA) treated at an academic rheumatology center. METHODS:We reviewed the medical records of all RA patients evaluated at an outpatient clinic between 2011 and 2016 to identify newly diagnosed and naive-to-treatment patients. We determined the durations between symptom onset and first rheumatology visit and time to initiate treatment. Data extraction included referral source, demographics, treatment, and laboratory tests. Routine use of a multidimensional health assessment questionnaire allowed us to calculate baseline RAPID3 (routine assessment of patient index data 3) scores. Comparisons between self-reported ethnicity/race groups were performed. We used logistic regression models to analyze associations between baseline variables and early referral. RESULTS:Data from 152 disease-modifying antirheumatic drug-naive RA patients were included in the study; 35% were white, 37% black, 20% Hispanic, and 8% other. The range in median time to first rheumatology visit was 6 to 8 months for all patient groups, except Hispanic. This group had a median time of 22.7 months (p = 0.01). The referral pattern was considerably variable between-groups; 40% of Hispanic patients were self-referred (p = 0.01). There were no statistically significant between-group differences for time to treatment initiation according to ethnicity/race. RAPID3 scores (p = 0.04) and erythrocyte sedimentation rates (p = 0.01) were significantly higher in the black and Hispanic groups. A high C-reactive protein value at baseline was associated with earlier referral. CONCLUSIONS:There is significant delay in initial presentation to a rheumatologist that was associated with a higher disease severity at presentation, especially for Hispanic patients.

译文

目的:本研究的目的是评估在学术风湿病学中心接受治疗的类风湿关节炎(RA)患者的按种族/种族划分的转诊和治疗延迟。
方法:我们回顾了2011年至2016年在门诊评估的所有RA患者的病历,以识别新诊断和初次治疗的患者。我们确定了症状发作与第一次风湿病就诊之间的持续时间以及开始治疗的时间。数据提取包括引荐来源,人口统计学,治疗和实验室检查。常规使用多维健康评估问卷可以使我们计算基线RAPID3(对患者指数数据3的常规评估)得分。比较自我报告的种族/种族群体。我们使用逻辑回归模型来分析基线变量和早期转诊之间的关联。
结果:该研究包括来自152例抗风湿性药物的初治性RA患者的数据; 35%是白人,37%黑色,20%西班牙裔和8%其他。除西班牙裔外,所有患者组首次风湿病就诊的中位时间范围为6到8个月。该组的中位时间为22.7个月(p = 0.01)。小组之间的推荐模式差异很大。 40%的西班牙裔患者是自我推荐的(p = 0.01)。根据种族/种族,治疗开始时间的组间差异无统计学意义。在黑人和西班牙裔人群中,RAPID3评分(p = 0.04)和红细胞沉降率(p = 0.01)显着更高。基线时高C反应蛋白值与较早转诊有关。
结论:风湿病学医师在初次就诊时出现了明显的延误,这与就诊时疾病的严重程度更高有关,特别是对于西班牙裔患者。

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