RT Journal Article SR Electronic T1 A quarter of patients time their early rheumatoid arthritis onset differently than physicians JF RMD Open JO RMD Open FD EULAR SP e000931 DO 10.1136/rmdopen-2019-000931 VO 5 IS 2 A1 Leah Ellingwood A1 Fatima Kudaeva A1 Orit Schieir A1 Susan J Bartlett A1 Louis Bessette A1 Gilles Boire A1 Glen S Hazlewood A1 Carol Hitchon A1 Edward Keystone A1 Diane Tin A1 Carter Thorne A1 Vivian P Bykerk A1 Janet Pope A1 , YR 2019 UL http://rmdopen.bmj.com/content/5/2/e000931.abstract AB 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.