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BMJ Open. 2019 Mar 4;9(3):e024361. doi: 10.1136/bmjopen-2018-024361.

Delays between the onset of symptoms and first rheumatology consultation in patients with rheumatoid arthritis in the UK: an observational study.

Author information

Division of Psychology, Nottingham Trent University, Nottingham, UK.
Wellcome Trust Clinical Research Facility, Queen Elizabeth Hospital Birmingham, Birmingham, UK.
Arthritis Research UK Primary Care Centre, Keele University, Keele, UK.
Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
Independent Research Consultant, Brussels, Belgium.
UCL School of Pharmacy, UCL, London, UK.
Department of Rheumatology, Derby Teaching Hospitals NHS Foundation Trust, Derby, UK.
Department of Rheumatology, St Georges University Hospital NHS Foundation Trust, London, UK.
Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK.
Department of Rheumatology, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK.



To investigate delays from symptom onset to rheumatology assessment for patients with a new onset of rheumatoid arthritis (RA) or unclassified arthritis.


Newly 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.


822 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).


This 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.


access to care; help-seeking; patient delay; primary care delay; rheumatoid arthritis

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Conflict of interest statement

Competing interests: None declared.

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