Barriers to Timely Rheumatologic Care for Rheumatoid Arthritis: A Real-World Questionnaire-based Study from Karnataka...

To assess referral timelines to rheumatologists in Karnataka, India, identify factors linked to delays, and to examine their impact on disease activity, functional disability, and economic burden.

A multicenter, cross-sectional, observational questionnaire-based study was conducted across 17 rheumatology centers in Karnataka, India (June, 2023-July, 2024). Disease activity (DAS28, CDAI), disability (HAQ-DI), and healthcare expenditure prior to referral and during the past 1 year were analyzed in relation to self-reported referral time, categorized as early (≤3 months from symptom onset) and late (>24 months). Utilization of healthcare schemes available in Karnataka was captured.

Among 2,141 participants with RA, the median referral time to a rheumatologist was 18 (6-36) months, early referral (≤3 months) in 17% (n = 365), and late referral (>24 months) in 31% (n = 662). Older age [AOR = 1.01 (1.005-1.02)], being married [AOR = 1.48 (1.03-2.12)], resident of non-Bengaluru regions [AOR = 2.26 (1.60-3.19)], academic treating facility [AOR = 2.32 (1.68-3.18)], and longer duration of illness >120 months [AOR =2.84 (2.14-3.76)] had higher odds of late referrals. This group had significantly higher expenditure prior to referral [β = 3.57 (3.05-4.19)], higher total annual medical expenditure [β = 1.20 (1.09-1.32)], and catastrophic expenditure [β = 1.56 (1.22-2.01)]. 52 % (n = 1120) of participants reported out-of-pocket healthcare expenditure.

Delayed referral to a rheumatologist was associated with increased disability and financial strain, including a significantly higher risk of catastrophic health expenditure.