Why Many RA Patients Close Their Own "Window"

Simons G, Mallen CD, Kumar K, et al., A Qualitative Investigation of the Barriers to Help-seeking Among Members of the Public Presented with Symptoms of New-onset Rheumatoid Arthritis. J. Rheum. 2015. First release Feb 1 2015. doi: 10.3899/jrheum.140913

A growing body of evidence points to a key problem for early recognition and treatment of rheumatoid arthritis (RA): People experiencing the first symptoms  often postpone seeing a physician because they think the joint pain and redness aren't serious.

This small study from the UK found that people with early RA symptoms feel that they can just manage the problem with over-the-counter medications. Whatdoes prompt calling for an appointment: Acute onset or symptoms that signal loss of ability to function.

Analyzing results of qualitative interviews with 38 people (6 men and 32 women) without a diagnosis of RA, these researchers found that people may call their symptoms “arthritis” but often attribute them to aging, wear-and-tear, an injury, or a pre-existing musculoskeletal problem.

Curiously, those who were aware their symptoms could be RA, because they had a friend or relative with the disease, said they might put off seeking care because they felt RA was inevitable.

Acute and sudden symptoms might trigger a quicker visit to the doctor, as opposed to symptoms that came on gradually, which often led to a “wait and see” attitude.

If they believed symptoms stemmed from an existing illness, interviewees said they’d probably manage them in a similar way to that condition.

These findings are almost identical to those from previous retrospective studies about reasons for delaying care for RA.^1,2

The studies all describe similar attitudes about calling physicians among patients with symptoms that might be RA: Feeling symptoms are too trivial to “waste” a doctor’s time, worry that the doctor might tell them to restrict their activities or prescribe a drug they didn’t want, not being able to “fit in” an office visit, or that they’d have to wait too long to get an appointment.

The current study identifies additional factors, such as the location of symptoms and the potential impact on daily functioning or work.

For example, some of the interviewees view painful joints in the feet as more serious, since they affect mobility. Others say they’d be more likely to get care sooner if their hands were involved, because that could impact day-to-day tasks. People also say they’d be more likely to take quicker action if their symptoms affected their work.

In a 2012 study by the same researchers at the Universities of Birmingham and Keele, patients with early RA symptoms waited an average of 12 weeks before consulting a physician.³

That's the same period that, rheumatologists agree, is the window of opportunity for early treatment with disease modifying anti-rheumatic drugs (DMARDs) in which to achieve significantly improved clinical outcomes. Thus many patients by their own actions are missing this window.

Researchers say these studies could provide the basis for efforts to help more people understand the importance of catching RA early in order to reduce its severity.

Disclosures:

1.  Townsend A, Backman CL, Adam P, Li LC. Women’s accounts of help-seeking in early rheumatoid arthritis from symptom onset to diagnosis.Chronic Illness. 2014; 10(4): 259–272. doi: 10.1177/1742395314520769

2.  Townsend A, Backman CL, Adam P, Li LC. A qualitative interview study: patient accounts of medication use in early rheumatoid arthritis from symptom onset to early postdiagnosis.BMJ Open. 2013;3:e002164. doi:10.1136/bmjopen-2012-002164

3. Stack RJ, Shaw K, Mallen CD, et al., Delays in help seeking at the onset of the symptoms of rheumatoid arthritis: a systematic synthesis of qualitative literature. Ann RheumDis. 2012;71:493-7