Early RA Journey - Patient Perspectives and Uncertainties Save

Canadian early RA (ERA) patients were interviewd to depict their perspectives from onset and diagnosis to referral and care. This report highlights the importance of patient pain and primary care physician (PCP) intake and referral. PCP and HCP delays in referral to a specialist still exist.

A total of 94 ERA patients from the Care in ERA (CareRA) trial were interviewed to discuss their experiences preceding diagnosis and the actions of the HCPs consulted by the patient. 

• Prevalent initial symptoms leading to their seeking medical care were pain (97%), swelling (73%) and stiffness (52%), typically in multiple joints.
• General practitioner (GP) was generally the first HCP to be contacted (87%). Patients were also first seen by rheumatologists (2%),orthopaedics (2%), neurologists (2%), physiotherapists (2%), and also emergency physicians, cardiologist, ophthalmologist and a podiatrist. 
• Reason for first HCP visit: intense pain (90.4%) and difficulties in performing daily activities (69%). Only 33% reported swelling and severe stiffness by 23%.
• HCP suspected RA (ERA) in 44% of patients at the first visit. 
• RA was susptected within 1-2 visits in 46%; 25% of patients needed more than five visits before suspecting ERA. 
• GPs referred to rheumatologists (71%), but multiple HCPs were often involved before RA detection and referral.

GP's (PCPs) play a pivotal role in early detection and correct referral. Furthermore, multiple HCPs are often involved, suggesting an educational deficit for both affected patients and PCPs.

"Referral to a rheumatologist is therefore sometimes delayed by clinical uncertainty, leading to several GP visits and longer treatment delays."