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Delays in help seeking at the onset of the symptoms of rheumatoid arthritis: a systematic synthesis of qualitative literature
  1. Rebecca J Stack1,2,
  2. Karen Shaw3,
  3. Christian Mallen4,
  4. Sandy Herron-Marx5,
  5. Rob Horne6,
  6. Karim Raza1,2
  1. 1School of Infection and Immunity, University of Birmingham, Birmingham, UK
  2. 2Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
  3. 3School of Health and Population Sciences, University of Birmingham, Birmingham, UK
  4. 4Arthritis Research UK Primary Care Centre, Keele University, Keele, UK
  5. 5Faculty of Health and Life Sciences, Coventry University, Coventry, UK
  6. 6School of Pharmacy, University of London, London, UK
  1. Correspondence to Dr Rebecca Jayne Stack, Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, The University of Birmingham, Birmingham B15 2TT, UK; r.stack{at}


A systematic review of qualitative peer-reviewed publications was conducted to identify drivers of and barriers to help-seeking behaviour in adults with new-onset rheumatoid arthritis (RA). 1058 abstracts were searched to identify relevant publications. 21 relevant publications were identified assessed for quality and subjected to analysis informed by thematic and grounded theory frameworks.

Several interacting themes were identified including the early experience of symptoms in relation to disease prototypes, minimising the impact of symptoms, speaking to others, gathering information and seeking alternative treatments, and issues related to accessing health services and attitudes towards healthcare professionals. Many people suggested that they had little knowledge of RA before diagnosis, believing RA to be a mild condition that affected older people. These misperceptions made correct symptom interpretation unlikely. Normalising and ignoring symptoms led people to delay in help-seeking. However, when symptoms impacted on daily activities help was usually sought. Individual interpretations of symptoms are both drivers of and barriers to help seeking. Targeted public health interventions are required to inform symptom interpretation and reduce delays.

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  • Funding This article presents independent research commissioned by the National Institute for Health Research (NIHR) under the Research for Patient Benefit Programme (funder's reference PB-PG-1208-18114). The views expressed in this publication are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.