Rheumatology Advance Access originally published online on August 18, 2008
Rheumatology 2008 47(10):1577-1582; doi:10.1093/rheumatology/ken304
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‘I just thought it was normal aches and pains’: a qualitative study of decision-making processes in patients with early rheumatoid arthritis
1Department of Rheumatology, Sandwell and West Birmingham Hospitals NHS Trust, 2MRC Centre for Immune Regulation, Division of Immunity and Infection and 3School of Health Sciences, The University of Birmingham, Birmingham, UK.
Correspondence to: K. Raza, MRC Centre for Immune Regulation, Division of Immunity and Infection, The University of Birmingham, Birmingham B15 2TT, UK. E-mail: k.raza{at}bham.ac.uk
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Abstract |
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Objective. Effective treatment can only be given during the early stages of RA if patients are seen early. However, many patients delay for prolonged periods before seeking medical advice. This study explores factors influencing the decision to seek medical advice in RA patients.
Methods. In-depth, semi-structured interviews were carried out with 24 patients. Purposive sampling ensured a cross-section in terms of time to presentation, gender, age and ethnic background. Interview transcripts were analysed and themes identified using established methods.
Results. Four main themes influenced the decision to seek medical advice: (i) symptom experience: the severity of symptoms and their impact on functional ability; (ii) symptom evaluation: the patient's explanation for their symptoms and recognition of their significance; (iii) knowledge of RA and available therapies; and (iv) experience of and attitudes towards health care providers. A significant and rapid impact of the disease on functional ability characterized those presenting early. Many developed an explanation for their symptoms that related to preceding activities. Recognition that this explanation was inadequate to explain symptom progression frequently prompted a consultation. Only one patient sought advice because she thought that she might have RA.
Conclusions. Symptom evaluation is a key factor influencing how quickly medical advice is sought in other diseases. In contrast to the situation with many cancers where there is widespread association of symptoms and signs with the eventual diagnosis, this was not the case in RA. Our findings should inform strategies to reduce delays in help-seeking in people with early RA.
KEY WORDS: Rheumatoid arthritis, Early arthritis, Delay, Presentation, Primary care
*J. Sheppard and K. Kumar equally contributed to this work.
Submitted 24 February 2008;
revised version accepted 3 July 2008.
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