Background Early identification of RA and early treatment is associated with a better disease outcome. Achieving early identification of RA requires that patients seek medical advice in time. Thus far motivations of patients with RA to seek medical help have been studied in relative small studies (around 30 patients per study, min 3, max 120 patients)1and have not been compared to the motivations of persons with joint complaints for other reasons.
Objectives We aimed to increase the comprehension of patients’ motivations & perceptions determining the urgency in which persons with joint complaints seek medical advice.
Methods We studied 612 patients with joint complaints that visited recently initiated Early Arthritis Recognition Clinics (EARC) in Leiden and Groningen; these screening clinics aim to identify arthritis very early by reducing the delay with which general practitioners send patients to rheumatologists (GP delay). At this clinic patients filled out a questionnaire with questions on their symptoms and their motivations to seek medical advice. The period between the first symptom and the first visit to the EARC was called the total delay and the period between the first symptom and the first visit to a general practitioner patient delay. Motivations were compared between patients with a short or prolonged patient delay, between patients with and without arthritis, and between men and women.
Results The median total delay was 10.5 (IQR 3.6-40.5) weeks, the median patient delay was 3.0 (IQR 0.7-12.9) weeks. 44.4% of the patients visiting the EARC had arthritis, in this subgroup the median patient delay was 2.1 (IQR 0.7-7.0) weeks. In all 612 patients frequently mentioned concerns to seek help were worsening of complaints (66%) and because of impairments in daily functioning (35%). The most frequent reason to postpone seeking medical help was the thought that complaints would pass (39%). Both in all patients and in arthritis patients, persons that sought help within 3 weeks after symptom onset had more often a sudden onset of complaints (P<0.001), experienced more often absentness of work (P<0.001), and had more impairments in daily functioning (P=0.004). In contrast, a longer patient delay (>3 weeks) was associated with a waxing and waning pattern of symptoms (P=0.011), the conception that the complaints would pass (P<0.001) and the belief that the symptoms were not serious (P=0.003). The patient delay was not significantly different between men and women (median 2.6 and 3.4 weeks resp.). Nevertheless, female patients reported more frequently progression of complaints as motivation to seek help (P=0.013), whereas men mentioned more often to be concerned about the cause of the complaints (P=0.03).
Conclusions This large-scale study observed several motivations and symptom characteristics influencing the urgency of persons with joint complaints to seek medical help. Especially arthritis patients with a gradual course of complaints did not consider their symptoms as ominous. These data can be helpful in order to define strategies aiming at early identification of arthritis.
Stack R.J, Shaw K, Mallen C et al. Ann Rheum Dis 2011 epub ahead of print.
Disclosure of Interest None Declared
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