Pos1310 Impact of a Multinational Awareness Campaign on Referral Patterns and Diagnostic Delays in Chronic Inflammatory Rheumatic Diseases: a Prospective Interventional Multinational Study
Year: 2025
Type: conference-abstract
Abstract: Background: Diagnosis and therapeutic delays are associated with worse disease prognosis in chronic inflammatory rheumatic diseases (CIRDs) including rheumatoid arthritis (RA), axial spondyloarthritis (axSpA) and psoriatic arthritis (PsA). While referral algorithms exist, the real-world effects of awareness campaigns on rheumatology referrals remain poorly studied. Objectives: To evaluate the impact of a multinational awareness campaign on the referral patterns of patients with CIRDs to rheumatology in Arab countries. Methods: This prospective, pre-post interventional study was conducted in 8 Arab countries from November 2023 to November 2024. Baseline referral patterns and diagnostic delays were evaluated in November 2023. Diagnostic delay was defined as the time from symptom onset to diagnosis among newly diagnosed CIRD patients. An awareness campaign targeting primary care physicians and other specialists was carried out from December 2023 to October 2024, featuring live webinars and social media posts advertised through the Arab League of Associations for Rheumatology (ArLAR) media channels. In September and October 2024, intensive live workshops were held in participating countries, utilizing a standardized referral algorithm previously validated by the same group. The main outcome was the change in the proportion of newly referred patients with RA, axSpA and PsA (collectively referred to as CIRDs) between November 2023 and November 2024 in 14 high-volume clinics. In addition, timelines from symptom onset to physician consultation and subsequent rheumatology diagnosis were evaluated in newly diagnosed CIRD patients and presented as medians and interquartile ranges (IQR), for all patients and by CIRD type. Factors associated with time from symptoms to diagnosis were analysed for all patients and by CIRD type using a multivariable linear regression. Results: In November 2024, 3616 patients were seen across the 14 clinics, 1031 (28.5%) were new patients and 383 (10.6%) were new CIRD patients (184 with RA, 136 with axSpA), and 63 with PsA). Among new patients, the proportion of newly referred patients with CIRDs increased from 31.4% to 37.1% (+5.8%, p<0.001). The proportion of new patients with RA increased from 16.6% to 17.8%, axSpA from 12.6% to 13.2%) and PsA from 2.1% to 6.1% (Table 1). Among newly referred CIRD patients (mean (SD) age 42.6 years (15.2), 62.7% females, median (IQR) disease duration 2.2 years (0.6;5.5), 147 RA, 127 axSpA, and 91 PsA), the median time in months (IQR) from symptom onset to diagnosis improved from 18.4 (5.8;48.7) to 12.0 (4.0;36.0) in all CIRDs. Specifically, in RA, the median time decreased from 12.2 months (IQR 2.9;25.2) to 9.0 months (IQR 3.0;18.0), in axSpA from 36.5 months (IQR 15.8;85.2) to 27.5 months (IQR 6.0;66.0), and in PsA from 24.3 months (IQR 5.7;70.2) to 12.0 months (IQR 4.0;38.5) (Figure 1). Factors significantly associated with diagnostic delay were longer disease duration (B= 4.969; p<0.001), lower education level (B=10.589; p=0.015), and longer time from symptom onset to any rheumatologist consultation (B=0.727; p<0.001). Conclusion: The multinational referral campaign was associated with increased referrals and reduced diagnostic delays for new patients with CIRDs. While the improvement may not be solely attributed to the campaign, the findings suggest a true positive impact on the referral of CIRD patients and their timely access to rheumatology care. Further long-term studies are warranted to confirm these findings. Figure 1Key timelines in the referral of new patients with CIRDs to rheumatology, before and after the multinational awareness campaign REFERENCES: NIL . Table 1Change in the proportion of new patients referred to 14 rheumatology clinics in 8 countries, before and after the multinational awareness campaign2023 (pre-campaign)2024 (post-campaign)Absolute difference in %p-valueN24903616New patients,N (%*)746(29.96%)1031(28.51%)-1.45%New patients with CIRDs,N (%**)234(31.37%)383(37.15%)+5.78%<0.001New patients with RA,N (%**)124(16.62%)184(17.85%)+1.23%<0.001New patients with axSpA,N (%**)94(12.60%)136(13.19%)+0.59%<0.001New patients with PsA,N (%**)16(2.14%)63(6.11%)+3.97%<0.001*Percentages from all patients (in columns)**Percentages from new patients (in columns) Acknowledgements: NIL . Disclosure of Interests: None declared . © The Authors 2025. This abstract is an open access article published in Annals of Rheumatic Diseases under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Neither EULAR nor the publisher make any representation as to the accuracy of the content. The authors are solely responsible for the content in their abstract including accuracy of the facts, statements, results, conclusion, citing resources etc.
Source: Annals of the Rheumatic Diseases
Language: English
Subfield: Rheumatology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $4,870
OpenAlex ID: W4411421237