Background According to the recommendations of EULAR 2007, every patient with persistent swelling of at least one joint should be referred to a rheumatologist and examined within 6 weeks from the onset of the first symptoms. Time from first symptoms to start of treatment on rheumatoid arthritis (RA) is only 12 weeks. Results of unique research conducted in Poland showed that diagnostic delay in RA is 35 weeks and it is one of the biggest in Europe. Early diagnosis has positive impact for effectiveness of treatment, cost economization and patient well-being.
Objectives The aim of the study was to determine the time passed since the onset of the first symptoms of rheumatic disease to the first visit the doctor. Additional objective of the study was to identify factors of the delay and of speeding up the diagnostic process.
Methods An anonymous questionnaire survey was carried out in the period from June 2014 to June of 2015 among patients treated in 6 rheumatological centers in different regions of Poland. The questionnaire consisted of 18 closed questions concerning: first symptoms of disease and actions taken by patient, absence in workplace/school, factors influencing patient's decision, path of patient from first contact with general practitioner (GP) to rheumatologist, diagnosed diseases and taking care of him/her own health. During the study 239 completed questionnaires were collected.
Results The first symptoms connected with rheumatic disease before contact with physician declared by respondents were: pain of the joints (86%), morning stiffness (71%), swelling of the joints (70%) and tiredness (69%). The greatest impact on searching help with the doctor were: worsening of symptoms (86%), difficulties in everyday activities (83%), talks with relatives (65%) and a fear that there are symptoms of severe disease (64%). The most important causes of delay of contact with physician were: limited access to physician (68%), belief that symptoms will pass spontaneously (56%) and lack of time to visit a doctor (45%). Only 17% of patients visit a doctor up to 7 days from first onset of rheumatic diseases (from 7 to 30 days - 32%; during 2–3 months - 23%; later than 3 month from first symptoms 28%). Before first visit to rheumatologist 97% of patients were treated by general practitioner (GP), 56% by orthopaedist, 41% - by neurologist.
Conclusions Patient's behaviour and the functioning of the health care system has an impact on delay of diagnosis of rheumatic diseases in Poland. One of the main problem identified by the study is GPs and other specialists low awareness of proper handling of a patient with early arthritis. As a result, the patient is treated in an inefficient way and referral to a rheumatologist as the disease is in the advanced stage.
Combe B, Landewe R, Lukas C, et al. EULAR recommendations for the management of early arthritis: report of a task force of the European Standing Committee for International Clinical Studies Including Therapeutic (ESCISIT). Ann Rheum Dis 2007; 66: 34–45.
Raza K, Stack R, Kumar K, et al. Delays in assessment of patients with rheumatoid arthritis: variations across Europe. Ann Rheum Dis 2011; 70: 1822–1825.
Disclosure of Interest None declared