Diagnostic Delay in Rheumatoid Arthritis Patients at a Tertiary Care Hospital: a Retrospective Obeservational Study

Abstract

ABSTRACT

Background: Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune disease in which early diagnosis and initiation of disease-modifying antirheumatic therapy are important for limiting persistent inflammation, joint damage, and long-term disability. Despite advances in diagnostic criteria and treatment, delays in diagnosis remain common, particularly in settings where access to specialist rheumatological care and effective referral pathways is limited. This study assessed the magnitude of diagnostic delay and factors associated with prolonged delay among patients with RA attending a tertiary-care hospital in Multan, Pakistan.

Objective: To determine the duration of diagnostic delay among patients with RA and assess its association with selected demographic and diagnostic characteristics, including age, sex, place of residence, and documented diagnostic approach.

Methods: A retrospective observational study was conducted at Mukhtar A. Sheikh Hospital, Multan, Pakistan, over a period of six months. A total of 103 patients with documented RA were included through retrospective consecutive sampling. Data were extracted from medical records regarding age, sex, residence, date of first rheumatology clinic visit, documented diagnostic approach, date of diagnosis, and total diagnostic delay in months. Diagnostic delay was summarized using mean ± standard deviation (SD) and median with interquartile range (IQR). Because diagnostic delay was positively skewed, non-parametric tests were used for inferential analysis. Spearman's rank correlation was used to assess the relationship between age and diagnostic delay, while the Mann–Whitney U test and Kruskal–Wallis test were used for comparisons between residence and diagnostic-approach groups, respectively. A p-value <0.05 was considered statistically significant.

Results: The mean age of participants was 38.11 ± 11.15 years, with a median age of 36 years (IQR: 28.5–48.0); 102 (99.0%) patients were female. The median diagnostic delay was 5 months (IQR: 3–8), with a mean of 7.75 ± 15.97 months and a range of 1–156 months. Overall, 67 (65.0%) patients experienced a diagnostic delay exceeding 3 months, while 35 (34.0%) experienced a delay exceeding 6 months. Diagnostic delay demonstrated a significant positive correlation with age (Spearman's ρ = 0.654, p <0.001). Patients aged ≥50 years had a median delay of 11 months compared with 3 months among those aged ≤29 years. Patients residing outside Multan had a significantly longer median diagnostic delay than those residing in Multan (10 vs. 4 months; Mann–Whitney U = 351.0, p <0.001). Diagnostic approach was also significantly associated with diagnostic delay (Kruskal–Wallis H = 11.01, p = 0.004), although the smaller size of some diagnostic subgroups limits interpretation.

Conclusion: Diagnostic delay was common among patients with RA attending this tertiary-care hospital, with approximately two-thirds experiencing a delay exceeding three months. Older age and residence outside Multan were significantly associated with longer diagnostic delays. Strengthening early recognition of inflammatory arthritis, improving referral pathways, and facilitating timely access to rheumatological services may help reduce diagnostic delays and promote earlier initiation of appropriate RA management.