{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T16:27:21Z","timestamp":1790872041323,"version":"4.1.0"},"reference-count":17,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2025,2,15]],"date-time":"2025-02-15T00:00:00Z","timestamp":1739577600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Musculoskeletal Care"],"published-print":{"date-parts":[[2025,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Early diagnosis of rheumatoid arthritis (RA) is crucial to prevent joint damage and improve treatment outcomes. RA cases that are not polyarticular at onset, and\/or are not beginning in the hand joints may face diagnostic delays, because of more convincing alternate diagnoses. This study examines the prevalence of onset pattern and location and its impact on diagnostic timing and disease progression in RA.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This prospective cross\u2010sectional study was conducted at Sandeman Provincial Hospital Quetta, Pakistan (January\u2013December 2022). Adults aged 17\u00a0years &amp; above with RA meeting ACR criteria 2010 were included using a consecutive sampling technique. The associations were measured by Chi\u2010squared and Cramer's V test. Bivariate and multinominal Regression models were used to analyse the duration and pattern of disease, delay in diagnosis and location of onset.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Twelve hundred RA patients (966, 82.8% female) with a median age of 42 (IQR: 33\u201355), and a median disease duration of 5\u00a0years (IQR: 2\u20138), both positively skewed, were included in the study. At\u2010least 408 (34%) patients had non\u2010polyarticular onset at initial presentation, and around 458 (38%) patients had the onset on illness not beginning in the small joints of hands. Non\u2010hand onset was significantly associated with age of onset, being 2.5 times higher in juvenile onset than in adult onset (OR\u00a0=\u00a02.515, <jats:italic>p<\/jats:italic>\u00a0=\u00a00.035). A diagnostic delay of 17.8\u00a0\u00b1\u00a027.9\u00a0months was found in the cohort, correlating significantly with total duration of disease (<jats:italic>p<\/jats:italic>\u00a0&lt;\u00a00.01), pattern of disease (polyarticular vs. non polyarticular, <jats:italic>p<\/jats:italic>\u00a0&lt;\u00a00.050) and with female gender (<jats:italic>p<\/jats:italic>\u00a0=\u00a00.014) but not with area of onset.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>RA onset outside the hands with non\u2010polyarticular patterns accounts for nearly one\u2010third of cases, emphasising the need for a more easily accessible rheumatology care to reduce delays and mitigate prolonged disease impact.<\/jats:p><\/jats:sec>","DOI":"10.1002\/msc.70068","type":"journal-article","created":{"date-parts":[[2025,2,15]],"date-time":"2025-02-15T14:23:36Z","timestamp":1739629416000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Impact of Disease Duration and Onset Pattern on Treatment Delays and Progression of Rheumatoid Arthritis: Insights From a Pakistani Cohort"],"prefix":"10.1002","volume":"23","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8067-0124","authenticated-orcid":false,"given":"Asadullah","family":"Khan","sequence":"first","affiliation":[{"name":"Department of Rheumatology Bolan Medical College Quetta  Quetta Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junaid","family":"Ahmed","sequence":"additional","affiliation":[{"name":"Department of Rheumatology Bolan Medical College Quetta  Quetta Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sakina","family":"Kazmi","sequence":"additional","affiliation":[{"name":"University of Balochistan  Quetta Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rabbey","family":"Raza Khan","sequence":"additional","affiliation":[{"name":"Bolan Medical College Quetta  Quetta Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naseer","family":"Ahmed","sequence":"additional","affiliation":[{"name":"Department of Rheumatology Bolan Medical College Quetta  Quetta Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ilsa","family":"Khan","sequence":"additional","affiliation":[{"name":"Bolan Medical College Quetta  Quetta Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,2,15]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.2147\/oarrr.s300838"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1186\/s42358\u2010023\u201000301\u20107"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1136\/rmdopen\u20102020\u2010001242"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/s0140\u20106736(16)30363\u20104"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.foot.2022.101907"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.34481"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.2478\/rir\u20102023\u20100033"},{"issue":"5","key":"e_1_2_11_9_1","article-title":"Foot Involvement as the First Manifestation in Rheumatoid Arthritis Patients in Lahore","volume":"13","author":"Khan S. A.","year":"2021","journal-title":"Cureus"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/s0140\u20106736(22)01193\u2010x"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/acr2.11251"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.12669\/pjms.37.4.3471"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1186\/s41927\u2010024\u201000392\u20109"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1097\/rhu.0000000000001196"},{"key":"e_1_2_11_15_1","first-page":"49","article-title":"Average Time Taken by a Rheumatology Patient to Reach a Rheumatologist in Pakistan 4","volume":"2","author":"Saif S.","year":"2022","journal-title":"Practice"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1002\/acr2.11258"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12891\u2010020\u201003364\u20105"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13047\u2010017\u20100229\u2010y"}],"container-title":["Musculoskeletal Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/msc.70068","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,13]],"date-time":"2025-04-13T03:01:56Z","timestamp":1744513316000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/msc.70068"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,2,15]]},"references-count":17,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2025,3]]}},"alternative-id":["10.1002\/msc.70068"],"URL":"https:\/\/doi.org\/10.1002\/msc.70068","archive":["Portico"],"relation":{},"ISSN":["1478-2189","1557-0681"],"issn-type":[{"value":"1478-2189","type":"print"},{"value":"1557-0681","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,2,15]]},"assertion":[{"value":"2025-01-27","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-02-07","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-02-15","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70068"}}