TY - JOUR T1 - Time to Disease-modifying Antirheumatic Drug Treatment in Rheumatoid Arthritis and Its Predictors: A National, Multicenter, Retrospective Cohort JF - The Journal of Rheumatology JO - J Rheumatol SP - 2088 LP - 2097 DO - 10.3899/jrheum.120100 VL - 39 IS - 11 AU - RUBEN TAVARES AU - JANET E. POPE AU - JEAN-LUC TREMBLAY AU - CARTER THORNE AU - VIVIAN P. BYKERK AU - JURIS LAZOVSKIS AU - KENNETH L.N. BLOCKA AU - MARY J. BELL AU - DIANE LACAILLE AU - CAROL A. HITCHON AU - AVRIL A. FITZGERALD AU - WESLEY K. FIDLER AU - ARTHUR A.M. BOOKMAN AU - JAMES M. HENDERSON AU - DIANNE P. MOSHER AU - DALTON E. SHOLTER AU - MAJED KHRAISHI AU - BOULOS HARAOUI AU - HONG CHEN AU - XIUYING LI AU - ANDREAS LAUPACIS AU - GILLES BOIRE AU - GEORGE TOMLINSON AU - CLAIRE BOMBARDIER Y1 - 2012/11/01 UR - http://www.jrheum.org/content/39/11/2088.abstract N2 - Objective. To determine the proportion of patients with rheumatoid arthritis (RA) under rheumatologic care treated with disease-modifying antirheumatic drugs (DMARD) within 6 months from symptom onset and the components of time to treatment and its predictors. Methods. A historical inception cohort of 339 patients with RA randomly selected from 18 rheumatology practices was audited. The proportion that initiated DMARD treatment within 6 months from symptom onset was estimated using Kaplan-Meier analysis. Time to each component of the care pathway was estimated. Multivariable modeling was used to determine predictors of early treatment using 12 preselected variables available in the clinical charts. Bootstrapping was used to validate the model. Results. Within 6 months from symptom onset, 41% (95% CI 36%−46%) of patients were treated with DMARD. The median time to treatment was 8.4 (interquartile range 3.8−24) months. Events preceding rheumatology referral accounted for 78.1% of the time to treatment. The most prominent predictor of increased time to treatment was a concomitant musculoskeletal condition, such as osteoarthritis or fibromyalgia. The significance of other variables was less consistent across the models investigated. Included variables accounted for 0.69 ± 0.03 of the variability in the model. Conclusion. Fewer than 50% of patients with RA are treated with DMARD within 6 months from symptom onset. Time to referral to rheumatology represents the greatest component delay to treatment. Concomitant musculoskeletal condition was the most prominent predictor of delayed initiation of DMARD. Implications of these and other findings warrant further investigation. ER -