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. 2017;55(4):169-176.
doi: 10.5114/reum.2017.69777. Epub 2017 Aug 31.

Diagnostic delays in rheumatic diseases with associated arthritis

Filip Raciborski  1 , Anna Kłak  2 , Brygida Kwiatkowska  3 , Bogdan Batko  4 , Małgorzata Sochocka-Bykowska  5 , Aleksandra Zoń-Giebel  6 , Zbigniew Gola  7 , Zbigniew Guzera  8 , Maria Maślińska  3 ; working team
Affiliations

Diagnostic delays in rheumatic diseases with associated arthritis

Filip Raciborski et al. Reumatologia. 2017.

Abstract

Objective: The objective of this study was to determine the length of delay in diagnosis of inflammatory rheumatic diseases, and to indicate the main factors responsible for such delays.

Material and methods: A retrospective multi-centre questionnaire survey carried out among 197 patients with diagnosed inflammatory rheumatic diseases or undergoing the diagnostic process.

Results: The most common early symptoms of inflammatory rheumatic disease included joint pain (94%), joint swelling (78%), morning joint stiffness (77%), fatigue (76%), and sleep disturbed by joint pain (74%). When asked about the reasons for seeking medical help, most patients indicated intensification of the symptoms (89%) and the fact that the symptoms made them unable to perform daily activities or work (86%). Limited access to specialists (70%) and the conviction that the symptoms will resolve spontaneously (57%) had the biggest impact on delaying a visit to a doctor. Before visiting a rheumatologist, the patients consulted their symptoms with their general practitioners (GPs, 95%), orthopaedicians (43%), and neurologists (29%). Almost half of the patients (48%) consulted their symptoms with at least 2 non-rheumatologists, whereas as many as 21% of patients visited 4 or more specialists. After the onset of symptoms of rheumatic disease, 28% of patients delayed seeing any doctor for 4 months or longer. 36% of patients waited 4 months or longer for a referral to a rheumatologist. The great majority of the patients (85%) made an appointment with a rheumatologist within a month of receiving a referral. 25% of patients waited 4 months or longer to see a rheumatologist.

Conclusions: Diagnostic delays result from both the level of patients' awareness (ignoring early symptoms) and improper functioning of the health care system. In the case of the health care system, the source of delays is not only "queues to rheumatologists", but also referring patients to non-rheumatologists.

Keywords: diagnostic delays; inflammatory rheumatic diseases; risk factors.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Fig. 1
Fig. 1
The percentage of people declaring the presence of given symptoms before seeing a doctor.
Fig. 2
Fig. 2
The percentage of people declaring the impact of a given factor on seeking medical help (A). The percentage of people declaring the impact of a given factor on delaying a visit to a doctor (B).
Fig. 3
Fig. 3
Doctors visited by patients with the symptoms of rheumatic disease, before the first visit to a rheumatologist.
Fig. 4
Fig. 4
Diagnostic delays in rheumatic diseases depending on the stage of diagnosis/treatment.
See this image and copyright information in PMC

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