AB1420-HPR Patient delay in rheumatoid arthritis. a survey on symptom interpretation before first visit to general practitioner

Abstract

BackgroundEarly initiation of effective treatment of rheumatoid arthritis (RA) leads to improved clinical and radiological status in the patients. Thus, there is a need to decrease the time from patients experience their first joint symptoms to initiation of treatment. The patient’ social context may influence the period from the patients experience their first joint symptoms until they present their symptoms to their general practitioner (GP) (patient delay (PD))ObjectivesFirstly, to explore whether socioeconomic and other factors influence PD in persons referred to a rheumatologist due to suspicion of RA. Secondly, if socioeconomic factors affected whether the patients subsequently received a diagnosis with inflammatory arthritis (IA)MethodsWe developed a survey based on previous Danish1,2 and UK3 studies regarding symptom interpretation and PD together with two patient research partners. We asked consecutive patients, referred to a rheumatology outpatient clinic or a private rheumatologist in the Region of Southern Denmark, with a suspicion of RA, to complete the survey online or in a paper version before examination by a rheumatologist. We used STATA/IC 15.0 for descriptive statistics, univariate, and multivariate logistic regression analyses.ResultsFrom December 2016 to July 2017, 144 patients completed the survey. In total 86 (60%) were female, mean age 55 (SD 15.3). In total 76 (53%) had short PD (0–3 months), 51 (35%) intermediate or long PD (≥4 months) (12% missing answers); 71 (49%) totally or partially agreed that their symptoms had a gradual onset. Three to seven months after the survey, 45 (22%) had received a diagnosis of some sort of inflammatory arthritis (IA). In the following analyses age was dicotomized (<or≥50 years). Age, sex, cohabitant status, educational level and whether patients undertook paid work or not, did not significantly affect the duration of PD. Female sex reduced the odds for an IA diagnosis compared to male sex (OR 0.35, p=0.05), but this did not reach significance in the multivariate analyses. Whether patients’ totally or partially agreed that they had: confidence to their general practitioner, felt they had support from others, whether their symptoms were obvious to others or significantly affected their work or leisure time, did not affect PD. Only gradual onset of symptoms significantly increased the odds for longer PD (OR 2.20, p=0.04)ConclusionsIn Denmark, socioeconomic factors did not seem to affect PD, but gradual onset of symptoms significantly increased the odds for median or longer PDReferences[1] Mølbaek Ket al. Musculoskeletal Care (2016)14(1):26–36.[2] Rasmussen S, et al. Int J Fam Med (2014) DOI: 10.1155/2014/187280.[3] Stack R, et al. Health Expectations (2015) 18(6): 2340–55.AcknowledgementsThanks to Rebecca Stack for sharing their survey and to patients, nurses and secretaries at the departments participating in the studyDisclosure of InterestNone declared