Diagnostic Delay in Rheumatoid Arthritis: A Qualitative Study of Symptom Interpretation Before the First Visit to the Doctor

Mølbaek, Karen; Hørslev‐Petersen, Kim; Primdahl, Jette

doi:10.1002/msc.1108

Cited by 22 publications

(21 citation statements)

References 20 publications

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“…Previous qualitative studies and a meta-synthesis have identified barriers to help seeking at the onset of RA 37–43. The present study identifies that before seeking formal medical attention, people experiencing the early symptoms of RA seek information and help from a number of alternative sources and often self-medicate.…”

Section: Discussionmentioning

confidence: 78%

Delays between the onset of symptoms and first rheumatology consultation in patients with rheumatoid arthritis in the UK: an observational study

et al. 2019

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ObjectiveTo investigate delays from symptom onset to rheumatology assessment for patients with a new onset of rheumatoid arthritis (RA) or unclassified arthritis.MethodsNewly presenting adults with either RA or unclassified arthritis were recruited from rheumatology clinics. Data on the length of time between symptom onset and first seeing a GP (patient delay), between first seeing a general practitioner (GP) and being referred to a rheumatologist (general practitioner delay) and being seen by a rheumatologist following referral (hospital delay) were captured.Results822 patients participated (563 female, mean age 55 years). The median time between symptom onset and seeing a rheumatologist was 27.2 weeks (IQR 14.1–66 weeks); only 20% of patients were seen within the first 3 months following symptom onset. The median patient delay was 5.4 weeks (IQR 1.4–26.3 weeks). Patients who purchased over-the-counter medications or used ice/heat packs took longer to seek help than those who did not. In addition, those with a palindromic or an insidious symptom onset delayed for longer than those with a non-palindromic or acute onset. The median general practitioner delay was 6.9 weeks (IQR 2.3–20.3 weeks). Patients made a mean of 4 GP visits before being referred. The median hospital delay was 4.7 weeks (IQR 2.9–7.5 weeks).ConclusionThis study identified delays at all levels in the pathway towards assessment by a rheumatologist. However, delays in primary care were particularly long. Patient delay was driven by the nature of symptom onset. Complex multi-faceted interventions to promote rapid help seeking and to facilitate prompt onward referral from primary care should be developed.

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Section: Discussionmentioning

confidence: 78%

Delays between the onset of symptoms and first rheumatology consultation in patients with rheumatoid arthritis in the UK: an observational study

et al. 2019

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“…The start of many illnesses can, though, be difficult to recognise, and may sometimes only be appreciated in retrospect, once a diagnosis has been reached 10. Symptoms vary according to disease and some may be more easily recognised as pathological than others 11…”

Section: Introductionmentioning

confidence: 99%

From breathless to failure: symptom onset and diagnostic meaning in patients with heart failure—a qualitative study

et al. 2017

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ObjectivesTo explore 2 key points in the heart failure diagnostic pathway—symptom onset and diagnostic meaning—from the patient perspective.DesignQualitative interview study.SettingParticipants were recruited from a secondary care clinic in central England following referral from primary care.ParticipantsOver age 55 years with a recent (<1 year) diagnosis of heart failure confirmed by a cardiologist following initial presentation to primary care.MethodsSemistructured interviews were carried out with 16 participants (11 men and 5 women, median age 78.5 years) in their own homes. Data were audio-recorded and transcribed. Participants were asked to describe their diagnostic journey from when they first noticed something wrong up to and including the point of diagnosis. Data were analysed using the framework method.ResultsParticipants initially normalised symptoms and only sought medical help when daily activities were affected. Failure to realise that anything was wrong led to a delay in help-seeking. Participants' understanding of the term ‘heart failure’ was variable and 1 participant did not know he had the condition. The term itself caused great anxiety initially but participants learnt to cope with and accept their diagnosis over time.ConclusionsGreater public awareness of symptoms and adequate explanation of ‘heart failure’ as a diagnostic label, or reconsideration of its use, are potential areas of service improvement.

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“…Based on the above findings, this present study demonstrated that COMP could be a useful laboratory marker for discriminating between patients with RA and healthy individuals, and it could also be used to judge the severity of the disease; findings that were in accordance with other research. 8 A previous study concluded that serum COMP was significantly higher in patients with RA compared with healthy subjects; and it was also significantly higher in patients with joint destruction compared with those patients in the early stages of the disease, but its levels were affected by age, disease duration, and body mass index. 29 In contrast, another study reported a sensitivity of 15%–48% and a specificity of 66%–69% for COMP as a marker for RA.…”

Section: Discussionmentioning

confidence: 96%

“… 6 , 7 These methods are often used to diagnose RA during the middle-to-late disease period when treatment is not able to effectively control the progressive articular and bone damage caused by the disease. 8 Research has confirmed that some biological markers reflecting cartilage degradation provide the possibility of early diagnosis. 7 Biomarkers may serve a wide range of purposes in clinical practice, but biomarker research must be the subject of a quantitative surrogate validation schema to ensure clinical and statistical validity.…”

Section: Introductionmentioning

confidence: 96%

Role of Serum cartilage oligomeric matrix protein (COMP) in the diagnosis of rheumatoid arthritis (RA): A case–control study

et al. 2016

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ObjectiveTo analyse the role of serum cartilage oligomeric matrix protein (COMP) levels in the differential diagnosis of rheumatoid arthritis (RA).MethodsThis case–control study analysed the clinical and laboratory characteristics of patients with RA and healthy control subjects. The diagnostic ability of COMP for RA was evaluated by comparing it with anti-cyclic citrullinated peptide antibody levels. The sensitivity, specificity, positive and negative predictive values were calculated.ResultsThe study enrolled 82 patients with RA and 34 healthy control subjects. The serum COMP level was significantly higher in patients with RA compared with control subjects (mean ± SD 29.51 ± 9.21 ng/ml versus 17.85 ± 5.55 ng/ml, respectively). The serum COMP level was significantly higher in patients with active RA compared with patients with RA in remission (mean ± SD 33.08 ± 8.80 ng/ml versus 24.94 ± 7.65 ng/ml, respectively). The cut-off value for COMP to discriminate patients with RA from healthy individuals was 21.51 ng/ml (sensitivity 0.817, specificity 0.882, positive predictive value 0.944, negative predictive value 0.667, and accuracy 0.836).ConclusionThe serum COMP level has the potential to be used as a biological marker for differentiating between patients with RA and healthy individuals.

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Diagnostic Delay in Rheumatoid Arthritis: A Qualitative Study of Symptom Interpretation Before the First Visit to the Doctor

Cited by 22 publications

References 20 publications

Delays between the onset of symptoms and first rheumatology consultation in patients with rheumatoid arthritis in the UK: an observational study

Delays between the onset of symptoms and first rheumatology consultation in patients with rheumatoid arthritis in the UK: an observational study

From breathless to failure: symptom onset and diagnostic meaning in patients with heart failure—a qualitative study

Role of Serum cartilage oligomeric matrix protein (COMP) in the diagnosis of rheumatoid arthritis (RA): A case–control study

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