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

Jayne Stack, Rebecca; Nightingale, Peter; Jinks, Clare; Shaw, Karen; Herron-Marx, Sandy; Horne, Rob; Deighton, Chris; Kiely, Patrick; Mallen, Christian; Raza, Karim

Abstract

OBJECTIVE: To investigate delays from symptom onset to rheumatology assessment for patients with a new onset of rheumatoid arthritis (RA) or unclassified arthritis. METHODS: Newly 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. RESULTS: 822 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). CONCLUSION: This 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.

Citation

Jayne Stack, R., Nightingale, P., Jinks, C., Shaw, K., Herron-Marx, S., Horne, R., …Raza, K. (2019). Delays between the onset of symptoms and first rheumatology consultation in patients with rheumatoid arthritis in the UK: an observational study. BMJ Open, 9(3), Article e024361. https://doi.org/10.1136/bmjopen-2018-024361

• Journal Article Type: Article
• Acceptance Date: Dec 13, 2018
• Online Publication Date: Mar 4, 2019
• Publication Date: Mar 4, 2019
• Journal: BMJ Open
• Electronic ISSN: 2044-6055
• Publisher: BMJ Publishing Group
• Peer Reviewed: Peer Reviewed
• Volume: 9
• Issue: 3
• Article Number: e024361
• DOI: https://doi.org/10.1136/bmjopen-2018-024361
• Keywords: access to care, help-seeking, patient delay, primary care delay, rheumatoid arthritis
• Publisher URL: http://doi.org/10.1136/bmjopen-2018-024361
• PMID: 30837252