Primary care consultation rates higher in 2 years prior to RA diagnosis
Patients who eventually develop rheumatoid arthritis have higher rates of primary care consultation at least 2 years prior to their physician’s first recorded suspicion that they may have the disease, according to findings published in Seminars in Arthritis and Rheumatism.
“Delay in diagnosis in primary care continues to be a significant contributor to overall diagnostic delay for people with RA,” Samantha Hider, MSc, PhD, of the Keele University Research Institute for Primary Care & Health Sciences in England, told Healio Rheumatology. “This could be because general practitioners are not aware of the need to refer quickly or because they find RA difficult to recognize.”
To determine whether patients later diagnosed with RA consulted more with their general practitioner, and whether specific signs and symptoms can be identified in the primary care record prior to a formal diagnosis, the researchers conducted a case-control study of information within the U.K. Clinical Practice Research Datalink. The researchers identified 3,577 patients with “definite” RA and matched them to 14,287 individuals without inflammatory arthritis. The date that the patient’s primary care physician first documented their suspicion that they may have RA was used as the index date.
The researchers then compared rates of consultation and consultations for suspected early RA symptoms, among both groups of patients, during the 2 years before the index date. They used conditional logistic regression adjusted for the number of consultations.
According to the researchers, rates of any consultation 2 years prior to the index date were significantly greater among patients with definite RA. In addition, patients with RA were more likely than the control individuals to have consultations for joint — specifically hand — symptoms (aOR = 11.44; 9.6-13.63), morning stiffness (aOR = 8.1, 3.54-18.5), carpal tunnel syndrome (aOR = 4.57, 3.54-5.88) and other nonarticular features.
“People later diagnosed with RA had higher rates of any consultation for at least 2 years prediagnosis — which may represent opportunities for screening or interventions,” Hider said. “People later diagnosed with RA were more likely to have consulted for joint pain and particularly to have consulted for hand symptoms before diagnosis. Other common consultations included for shoulder pain and carpal tunnel syndrome. Delay at the [general practitioner] level remains important. People shoulder consider RA in people consulting with hand symptoms and enquire about additional possible inflammatory symptoms.” – by Jason Laday
Disclosure: Hider reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.