Search

ObjectiveTo investigate delays from symptom onset to rheumatology assessment for patients with a new onset of rheumatoid arthritis (RA) or unclassified arthritis.MethodsNewly presenting adults with either RA or unclassified arthritis were recruited from rheumatology clinics. Data on the length of time between symptom onset and first seeing a GP (patient delay), between first seeing a general practitioner (GP) and being referred to a rheumatologist (general practitioner delay) and being seen by a rheumatologist following referral (hospital delay) were captured.Results822 patients participated (563 female, mean age 55 years). The median time between symptom onset and seeing a rheumatologist was 27.2 weeks (IQR 14.1–66 weeks); only 20% of patients were seen within the first 3 months following symptom onset. The median patient delay was 5.4 weeks (IQR 1.4–26.3 weeks). Patients who purchased over-the-counter medications or used ice/heat packs took longer to seek help than those who did not. In addition, those with a palindromic or an insidious symptom onset delayed for longer than those with a non-palindromic or acute onset. The median general practitioner delay was 6.9 weeks (IQR 2.3–20.3 weeks). Patients made a mean of 4 GP visits before being referred. The median hospital delay was 4.7 weeks (IQR 2.9–7.5 weeks).ConclusionThis study identified delays at all levels in the pathway towards assessment by a rheumatologist. However, delays in primary care were particularly long. Patient delay was driven by the nature of symptom onset. Complex multi-faceted interventions to promote rapid help seeking and to facilitate prompt onward referral from primary care should be developed.

This abstract presents reflections on recruiting and involving South Asian patients with rheumatoid arthritis (RA) in research; it draws on the first author9s experiences of leading a qualitative study which explored South Asian patients9 perceptions of communicating the risk of developing RA with relatives. RA is a chronic inflammatory condition that may lead to long-term disability and co-morbidities. First-degree relatives are at increased risk. Access to this group is dependent on the co-operation of patients with RA; it is therefore important to understand patients9 perceptions of risk and their willingness to communicate risk with relatives. Fifteen patients of South Asian origin were recruited in a secondary rheumatology clinic. Participants were also approached to act as patient research partners (PRPs) and help with interpreting and validating the data. We adopted a culturally competent approach: cultural competency entails understanding that socio-cultural factors influence patient participation in research and ensures that these influences do not become a basis for exclusion. South Asian groups are frequently considered ‘hard to reach’ – a label which suggests a lack of engagement on their part rather than institutional barriers. The conventional approach, commonly adopted by qualitative researchers, can serve to exclude people by, for example, including only people who speak English. As a researcher from a South Asian background, the author found her shared identity, languages and experiences helped to facilitate recruitment, build rapport and involve participants as PRPs.