RESEARCH - Delay in presentation to primary care physicians is the main reason why patients with RA are seen late by rheumatologists

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Rheumatology Advance Access published online on June 19, 2007

Delay in presentation to primary care physicians is the main reason why

patients with rheumatoid arthritis are seen late by rheumatologists

K. Kumar1,2, E. Daley1, D. M. Carruthers1, D. Situnayake1, C. Gordon1,2, K.

Grindulis1, C. D. Buckley1,2, F. Khattak1 and K. Raza1,2

1Department of Rheumatology, Sandwell and West Birmingham Hospitals NHS

Trust and 2MRC Centre for Immune Regulation, Division of Immunity and

Infection, The University of Birmingham, Birmingham, UK

Abstract

Objectives. To study the delay from the time of symptom onset to assessment

by a Rheumatologist in patients with rheumatoid arthritis (RA) and to

determine the contributions of patient and physician dependent factors to

this delay.

Methods. Data were collected from 169 consecutive patients with RA at the

time of assessment by Rheumatologists working in hospitals serving an inner

city population in Birmingham, UK. Dates were recorded for: (i) onset of

inflammatory joint symptoms; (ii) initial assessment in primary care; and

(iii) referral from primary to secondary care. (iv) initial assessment by a

rheumatologist in secondary care.

Results. The median delay from the onset of symptoms to a patient being

assessed in secondary care was 23 weeks (IQR 12-54 weeks). The median delay

before the patient was assessed in primary care was 12 weeks (IQR 4-28

weeks). For 96 patients (57%) more than half of the overall delay in

assessment in secondary care was accounted for by a delay in assessment in

primary care.

Conclusions. Patient dependent factors, leading to a delay in consulting

primary care physicians, are the principal reasons for the delay in patients

with RA being seen by Rheumatologists in our population. A considerable body

of evidence demonstrates that the earlier that therapy is introduced the

better the clinical outcome. Consequently it is important to understand why

some patients with RA delay in seeking medical advice, in order to allow

effective interventions to reduce this delay.

http://rheumatology.oxfordjournals.org/cgi/content/abstract/kem130v1

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