Background After symptom onset, persons later on diagnosed with Early Rheumatoid Arthritis (ERA), often delay their contact with a health care professional (HCP). Moreover, some HCPs do not feel confident in ERA detection1. Therefore, a better understanding of patients' perception of the first symptoms of RA and their interaction with HCPs could aid in decreasing treatment delay in ERA.
Objectives To investigate in detail the help-seeking trajectory in patients with ERA from symptom onset until referral to a rheumatologist.
Methods In the present cross-sectional study, 94 DMARD-naive patients with ERA enrolled in the CareRA trial were included. Participants were recruited in 1 academic center. During a clinical visit, they were questioned about initial ERA-related experiences using a self-developed assessment form. The first part of the form focused on patients' perception of initial symptoms and their help-seeking behavior, including the nature of first symptoms, concurrent events at symptom onset, the first HCP visited and the reasons for consulting a HCP. The second part emphasized the actions undertaken by the consulted HCP until referral, including the detection procedure leading to recognition of initial symptoms as ERA-related, other disorders considered and the number of visits before ERA was detected.
Results Of the 94 participants, mean ± SD age was 52±14 years, 75% were women, 62% were RF positive and 73% ACPA positive. As first ERA symptoms, patients reported joint pain (97%), limited joint mobility (42%) and joint swelling (73%), typically in multiple joints. Other symptoms experienced were fatigue (21%) and morning stiffness (33%). Eight patients described loss of strength or redness in the affected joints. Physical overburdening or emotional stress was stated by 14 patients as concurrent event at symptom onset. Generally, the general practitioner (GP) was the first contacted HCP (86%). The most frequently reported reasons to visit a HCP were too much pain (90%), prominent swelling (33%) and difficulties in performing daily activities (69%). In 42% of the patients, the HCP suspected the symptoms to be ERA-related. Before ERA was detected, 26% of the patients required 1 visit, 22% needed 2 visits, 13% needed 3 visits, 7% needed 4 visits, 7% needed 5 visits and 25% needed >5 visits. According to the patients, local inflammation (23%) and muscular conditions (21%) were considered as the most likely diagnosis by the HCP. A blood test was performed in 73% and pain medication was prescribed in 57% of the patients before referral. The HCP mainly referred patients to a rheumatologist (71%) and less frequently to other specialists, such as an orthopedic surgeon (10%).
Conclusions Pain is the foremost remembered ERA-related symptom at onset and the most important reason to visit a HCP, mostly the GP. Furthermore, 25% of patients needed >5 visits before ERA was detected. There are opportunities to make ERA detection more efficient and decrease treatment delay.
Meyfroidt S, Stevens J, De Lepeleire J, Westhovens R, De Cock D, Van der Elst K, Vanhaecht K, Verschueren P. From symptom onset to effective early rheumatoid arthritis care: the general practitioners' perspective. Submitted for peer review.
Disclosure of Interest None declared