Symptom Complexes at the Earliest Phases of Rheumatoid Arthritis: A Synthesis of the Qualitative Literature

Abstract

ObjectiveUnderstanding the features and patterns of symptoms that characterize the earliest stages of rheumatoid arthritis (RA) is of considerable importance if patients are to be identified and started on treatment early. However, little is known about the characteristics of symptoms at the onset of a disease that eventually progresses to RA.MethodsA systematic review of qualitative peer-reviewed publications was conducted to identify the earliest symptoms associated with the onset of RA. A total of 1,736 abstracts were searched to identify relevant publications. Twenty-six publications were identified, assessed for quality, and subjected to analysis informed by thematic and grounded theory frameworks.ResultsSeveral interacting themes describing the early symptoms of RA were identified, including swelling, pain and tenderness, stiffness, fatigue and weakness, and the emotional impact of symptoms. For each symptom, different and evolving intensities were described; in some cases, patterns of symptom onset and symptom complexes at the onset of RA were highlighted. Importantly, this review has emphasized major deficiencies in the literature. None of the studies reviewed originally aimed to explore symptoms at RA onset (often discussions about symptom onset were secondary to the study's primary aim). Also, many of the articles identified sampled people diagnosed with RA many years previously, making their recollection of symptoms at onset less reliable.ConclusionIn order for clinicians to fully understand the earliest phases of disease, the nature of symptoms at onset needs to be understood. The current work represents a useful starting point, but this area needs further qualitative investigation, followed by quantitative explorations of symptom clusters and their associated features.

A review of the neuro- and systemic inflammatory responses in post concussion symptoms: Introduction of the “post-inflammatory brain syndrome” PIBS

“…The fatigue in RA does appear, however, to at least by partially mediated by cytokine induced hypothalamic-pituitary-adrenal (HPA) axis dysfunction (Choy, 2012). Fatigue in fact appears to be one of the earliest symptoms at the onset of RA (Stack et al, 2013). Similarly use of an anti-TNF agent also significantly reduced fatigue in patients with RA (Mease, 2011).…”

I Would Never Take Preventive Medication! Perspectives and Information Needs of People Who Underwent Predictive Tests for Rheumatoid Arthritis

“…Since RA is commonly preceded by a phase of immunologic abnormalities, including the presence of anti–citrullinated protein antibodies (ACPAs) and low‐grade inflammation , future interventions might start even earlier by identifying and treating individuals who are at risk of developing RA (e.g., those with a first‐degree relative with RA and patients with clinically suspect arthralgia or undifferentiated arthritis) before the development of clinically apparent polyarthritis . Therefore, researchers have explored predictive testing methods involving blood‐based biomarkers and imaging (e.g., ultrasound and magnetic resonance imaging), as well as more invasive methods like synovial biopsies in the time preceding RA.

To our knowledge, this study explored for the first time experiences of being tested, as well as information and support needs, of people with arthralgia and asymptomatic individuals who underwent predictive biomarker testing for rheumatoid arthritis (RA) and who had a positive test result. All individuals expressed the need for tailored, patient‐understandable information on predictive testing. Most of them emphasized the advantage of knowing as early as possible that they were at risk for developing RA. Individuals with arthralgia were more likely to be willing to take preventive action, undergo further testing, and experience psychological distress than asymptomatic individuals. Because individuals at risk of RA are currently the subjects of research aimed at developing better predictive strategies and preventive approaches, their perceptions and needs should be addressed to inform the future development of interventions combined with education.

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“…Since RA is | 361 commonly preceded by a phase of immunologic abnormalities, including the presence of anti-citrullinated protein antibodies (ACPAs) and low-grade inflammation (8)(9)(10)(11)(12), future interventions might start even earlier by identifying and treating individuals who are at risk of developing RA (e.g., those with a first-degree relative with RA and patients with clinically suspect arthralgia or undifferentiated arthritis) before the development of clinically apparent polyarthritis (13,14). Therefore, researchers have explored predictive testing methods involving blood-based biomarkers and imaging (e.g., ultrasound and magnetic resonance imaging), as well as more invasive methods like synovial biopsies (6,8,(15)(16)(17)(18)(19)(20) in the time preceding RA.…”

Balancing the autonomic nervous system to reduce inflammation in rheumatoid arthritis

“…RA usually manifests itself between the age of 45 and 55 and clinical signs and symptoms include painful, swollen and stiff joints and fatigue [2]. Arthritis is caused by synovial inflammation, and persistence hereof leads to bone erosions, cartilage damage and ultimately joint deformities and disability [3].…”