Early diagnosis of rheumatoid arthritis: associations between patients’ perceptions of initial symptoms and the timing of seeking help from the general practitioner

Abstract

Objectives: Early diagnosis is essential to the prognosis of rheumatoid arthritis (RA), but little is known about patients’ perceptions of the first symptoms. Illness representations shape patients’ help-seeking behaviour. The Illness Perception Questionnaire–Revised (IPQ-R) can measure these, allowing us to understand the patients’ role in diagnostic delays. The aim of this study was to explore the connection between RA patients’ perceptions of initial symptoms and the time taken to seek help from a general practitioner (GP). Method: 1163 recently diagnosed individuals with RA, identified from the Danish Rheumatology Database, DANBIO, filled out a questionnaire. We used adjusted multivariable linear regression to calculate the median ratio (MR) for those with the highest scores within each IPQ-R subscale compared to the lowest scores. Results: Altogether, 404 patients answered the questionnaire. The overall median patient delay was 63 [interquartile range (IQR) 17–214] days. Younger patients experienced longer delays than older [84 (IQR 30–361) vs 54 (14–162) days]. High expectations of treatment control led to 54% lower median time to first GP contact compared to low expectations [adjusted median ratio (MR) 0.54, 95% confidence interval (CI) 0.29–0.99]. High perceptions of symptom variability at disease onset led to a higher median time to first GP contact (adjusted MR 1.61, 95% CI 0.93–2.78). Conclusion: People with RA symptoms may delay seeing their GP due to low expectations of treatment effectiveness and significant symptom variability. Information campaigns could educate patients on recognizing warning signs and encourage them to seek medical attention.