The Journal of the Association of Physicians of India · 2026
Barriers to Timely Rheumatologic Care for Rheumatoid Arthritis: A Real-World Questionnaire-based Study from Karnataka Chapter of Indian Rheumatology Association (KRA).
СтатьяНаблюдательное исследованиеМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
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Shobha Vineeta, Subramanian R, Prakruthi J, Selvam Sumithra, Shaleni V, Haridas Vikram, Mamadapur Mahabaleshwar, Kamath Ashwini, Arjun M N, Chebbi Pramod, Vahaneyil Jacob Mathews, Vr Silas Vinay, Patil Abhishek, Pinto Benzeeta, Yathish G C, Jeevanagi Sachin R, Baliga Sahana, Harshini A S, Singhai Shweta, Rao Vijay K, Ramachandran Veena, Anusha Matam Sri, Chandrashekara S, Mahendranath K M
Аннотация
INTRODUCTION: 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.
MATERIALS AND METHODS: 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.
RESULTS: 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.
CONCLUSION: Delayed referral to a rheumatologist was associated with increased disability and financial strain, including a significantly higher risk of catastrophic health expenditure.
MATERIALS AND METHODS: 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.
RESULTS: 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.
CONCLUSION: Delayed referral to a rheumatologist was associated with increased disability and financial strain, including a significantly higher risk of catastrophic health expenditure.