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A quarter of patients time their early rheumatoid arthritis onset differently than physicians
  1. Leah Ellingwood1,
  2. Fatima Kudaeva1,
  3. Orit Schieir2,
  4. Susan J Bartlett3,4,
  5. Louis Bessette5,
  6. Gilles Boire6,
  7. Glen S Hazlewood7,
  8. Carol Hitchon8,
  9. Edward Keystone9,
  10. Diane Tin10,
  11. Carter Thorne11,
  12. Vivian P Bykerk12,13 and
  13. Janet Pope1
  14. on behalf of the CATCH Investigators
    1. 1Medicine, Division Rheumatology, Western University, London, Ontario, Canada
    2. 2McGill University Centre for Bioinformatics, Montreal, Québec, Canada
    3. 3Clinical Epidemiology, McGill University, Montreal, Québec, Canada
    4. 4Division of Rheumatology, Johns Hopkins, Baltimore, Maryland, USA
    5. 5Groupe de Recherche en Rhumatologie et Maladies Osseuses, Sainte-Foy, Québec, Canada
    6. 6Medicine, Division of Rheumatology, University of Sherbrooke, Sherbrooke, Quebec, Canada
    7. 7Medicine, Division of Rheumatology, University of Calgary, Calgary, Alberta, Canada
    8. 8Medicine, Division of Rheumatology, University of Manitoba, Winnipeg, Manitoba, Canada
    9. 9Medicine, Division of Rheumatology, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
    10. 10Medicine, Suthlake Regional Health Centre, Newmarket, Ontario, Canada
    11. 11Medicine, Division of Rheumatology, Southlake Regional Health Centre, Newmarket, Ontario, Canada
    12. 12Rheumatology, Hospital for Special Surgery, New York City, New York, USA
    13. 13Mount Sinai Hospital, Toronto, Ontario, Canada
    1. Correspondence to Dr Janet Pope; janet.pope{at}


    Objective Early rheumatoid arthritis (RA) treatment requires timely recognition. This large, multicentre study compared patient-reported vs physician-reported onset of early RA.

    Methods Patients from the Canadian Early ArThritis CoHort with early/suspected RA (persistent synovitis <1 year) completed questionnaires asking about the date of symptom onset; and rheumatologists date of onset for persistent synovitis. Groups with similar reported timing (patient and physician) versus differing timing of 30 days or more were compared.

    Results In 2683 patients, the median patient symptom duration (IQR) was 178 days (163) and physician-reported duration was 166 (138). 1940 (72%) patients had similar patient-reported and physician-reported onset (<30 days), whereas 497 (18%) reported onset 30 or more days preceding physicians, and 246 (9%) 30 or more days after physicians. Patients reporting onset preceding physicians had lower baseline Disease Activity Score based on 28 joint count, swollen joint counts and erythrocyte sedimentation rate (p<0.05). Patients reporting onset after physicians were more likely to be rheumatoid factor positive (p<0.001) and had higher anticitrullinated protein antibody titres (p<0.009). Regression showed low income, smoking, fibromyalgia, osteoarthritis and baseline non-methotrexate non-biological disease-modifying antirheumatic drug use were predictors for longer patient-reported symptoms. At 12 months, patients reporting longer symptom duration than physicians had lower rates of Simplified Disease Activity Index remission and higher physician global assessments.

    Conclusion Over one-fourth of patients reported differences of >1 month in symptom onset from their rheumatologist. Patients with longer symptom durations had less improvement at 1 year, which may be reflective of comorbid musculoskeletal conditions.

    • rheumatoid arthritis
    • early rheumatoid arthritis
    • symptom onset
    • early inflammatory arthritis
    • RF
    • ACPA
    • incident cohort

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    • Contributors All authors contributed to reviewing the data, reviewing the paper and approving the paper. LE, FK, OS, JP performed the analyses. LE and JP wrote the initial draft. LB, GB, GSH, CH, EK, DT, CT, VPB, JP all collected data on their patients in CATCH.

    • Funding The CATCH study was designed and implemented by the investigators and financially supported through unrestricted research grants from: Amgen and Pfizer Canada—Founding sponsors since January 2007; UCB Canada, AbbVie Corporation and Bristol-Myers Squibb Canada since 2011; Medexus Inc. since 2013; Eli Lilly Canada since 2016; Merck Canada since 2017 and Sandoz Canada Pharmaceuticals since 2018. Previously funded by Hoffmann-LaRoche and Janssen Biotech from 2011 to 2016, and Sanofi Genzyme from 2016 to 2017.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval All sites had institutional review board approval. All patients signed informed consent. The study was conducted according to Declaration of Helsinki.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available on reasonable request.

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