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

Area of Science:

• Rheumatology
• Public Health
• Health Economics

Background:

• Rheumatoid arthritis (RA) diagnosis and management often involve delays in specialist referral.
• Understanding referral timelines is critical for improving patient outcomes in RA care.
• Timely access to rheumatologists impacts disease control and patient well-being.

Purpose of the Study:

• To evaluate referral timelines to rheumatologists in Karnataka, India.
• To identify factors contributing to delayed rheumatologist referrals for RA patients.
• To assess the impact of referral delays on disease activity, disability, and economic burden.

Main Methods:

• A multicenter, cross-sectional, observational study involving 2,141 RA participants across 17 rheumatology centers in Karnataka.
• Data collected via questionnaires on referral times, disease activity (DAS28, CDAI), disability (HAQ-DI), and healthcare expenditure.
• Referral times categorized as early (≤3 months) and late (>24 months) from symptom onset.

Main Results:

• Median referral time to a rheumatologist was 18 months; 31% experienced late referrals (>24 months).
• Factors associated with late referrals included older age, marital status, non-Bengaluru residence, academic facilities, and longer illness duration.
• Late referrals correlated with significantly higher pre-referral and annual medical expenditures, and increased risk of catastrophic health expenditure.

Conclusions:

• Delayed rheumatologist referral in RA patients is linked to increased functional disability.
• Patients facing delayed referrals experience greater financial strain and a higher likelihood of catastrophic health expenditure.
• Optimizing referral pathways is essential for mitigating the adverse effects of delayed RA diagnosis and treatment.