Referral Delays in Rheumatoid Arthritis Patients Linked to Physician Reluctance, Knowledge Gaps, and Patient Factors: Study

A study published in the Journal of The Association of Physicians of India, suggests both patient and healthcare professional factors are responsible for referral delays in RA patients. Limited knowledge of rheumatology, lack of rheumatologists, and hesitation in referring patients to specialists are the major contributing factors causing referral delays.

RA is a chronic autoimmune disorder that affects joints, leading to inflammation, pain, swelling, and eventual joint destruction. The delayed introduction of disease-modifying antirheumatic drugs (DMARDs) has led to major challenges in RA management, increased disease burden, and treatment outcomes.

To find out the leading cause behind delayed referral and treatment, Chandrashekara S Managing Director, Department of Rheumatology and Clinical Immunology, Bengaluru, Karnataka, India, and colleagues gathered to carry out a prospective, multicenter, observational study that enrolled 4,643 RA patients from eight centers using the Indian Rheumatology Association (IRA) database.

Factors related to the patient and referral were identified based on the patient's account. Modified PRASAD scale to categorize patients’ socioeconomic status.

Results reveal the following findings:

• The predominant factor causing delay was a lack of awareness
• 39% of patients were referred to the rheumatology specialty within 6 months of disease onset, while 26% reported later, and 34% reported over 2 years.
• Socioeconomic factors lead to referral delays in Madhya Pradesh (21.43%) and West Bengal (28.57%).
• Lack of awareness about the disease and rheumatology specialty was highest in West Bengal (100%), followed by Delhi and Rajasthan (93.70%).
• Other factors influencing referral delay were misconceptions about modern medicine, reluctance to refer patients to the rheumatologist, and previous treatment by other specialties.
• In Gujarat (33.56%) and Delhi and Rajasthan (25.18%) primary care clinicians' lack of awareness about the rheumatology specialty was the main reason for the delay in referrals.

“The study's findings may be limited in their generalizability due to uneven recruitment from various centers, lack of geographic representation, and potential recall bias,” researchers reported.

Reference: S Chandrashekara, Shenoy Padmanabh et al. Blockades in the Pathway of Specialty Care in Rheumatoid Arthritis: A Report Based on Indian Rheumatology Association Database. Journal of the Association of Physicians of India, 72(8).doi: 10.59556/japi.72.0495.