類風濕性關節炎之延遲診斷－－以中華民國類風濕性關節炎之友會員為例

Delay in diagnosis of rheumatoid arthritis in members of the Taiwan Rheumatoid Arthritis Aid Group

目的：為瞭解類風濕性關節炎病患之就醫過程以了解延遲診斷。方法：本研究主要針對類風濕性關節炎病患之基本資料、就醫歷程、工作等面向設計一結構式封閉型問卷，於2012年中華民國類風濕性關節炎之友協會年會，發放本研究問卷。以不計名方式，由已經獲得重大傷病卡的類風濕性關節炎病患填寫，共回收有效樣本114份。從症狀出現到初次就診定義為“病患延遲”，從初次就診到確定診斷定義為“醫療延遲”。結果：114位病友中106位是女性；平均年齡（標準差）為58.27 （11.04）歲，病患延遲和醫療延遲的中位數各為6周和8周，平均病患延遲和醫療延遲各為48.33和46.63周，全部延遲診斷的中位數為23周，男女之間無顯著意義差別（16 vs. 25周）；男性的病患延遲顯著比女性短（1 vs. 6周），男性的醫療延遲較女性長，但無顯著意義差別（16.5 vs. 8 周）；沒有全職工作者的全部延遲診斷時間比有全職工作者長（12 vs. 28 weeks, p=0.007）。結論：本研究顯示，類風濕性關節炎病患，從症狀出現到確定診斷長達數月。顯示病患的健康職能需要提升，醫界也應該加速類風濕性關節炎的診斷。

Aim: To quantify delays in the diagnosis of patients with rheumatoid arthritis. Methods: Subjects were recruited from among members of the Rheumatoid Arthritis Aid Group of the ROC who participated in the 2012 annual meeting. Variables on the questionnaires included gender, age, education, marital status and full-time job. The lag time between disease onset and the first encounter with a physician was recorded as the “patient delay”. The time between first encounter and the definite diagnosis was recorded as the “medical delay”. Results: Of the 114 respondents, 106 (93%) were females; the mean (SD) age was 58.27 (11.04) years, and the mean (SD) duration of disease was 16.48 (11.19) years. The median of patient and medical delay was 6 and 8 weeks, respectively. The median of the total lag time was 23 weeks, with no difference between men and women (16 vs. 25 weeks). The patient delay among women was significantly longer than that among men (1 vs. 6 weeks). The medical delay was longer for men than for women, without a significant difference (16.5 vs. 8 weeks). There was a longer total lag time among those without a full-time job than among in those who worked full time (12 vs. 28 weeks, p=0.007). Conclusions: Our study indicates quite long lag times between disease onset and the first encounter with a physician and the time between first encounter and the definite diagnosis among patients with rheumatoid arthritis. More efforts are needed to improve health education, in order to hasten the diagnosis and improve the treatment.