title: Delay in presentation to primary care physicians is the main reason why patients with rheumatoid arthritis are seen late by rheumatologists.
abstract: OBJECTIVE
  To study the delay from the time of symptom onset to assessment by a Rheumatologist in patients with rheumatoid arthritis (RA) and to determine the contributions of patient and physician dependent factors to this delay.
  
  
  METHODS
  Data were collected from 169 consecutive patients with RA at the time of assessment by Rheumatologists working in hospitals serving an inner city population in Birmingham, UK. Dates were recorded for: (i) onset of inflammatory joint symptoms; (ii) initial assessment in primary care; and (iii) referral from primary to secondary care. (iv) initial assessment by a rheumatologist in secondary care.
  
  
  RESULTS
  The median delay from the onset of symptoms to a patient being assessed in secondary care was 23 weeks (IQR 12-54 weeks). The median delay before the patient was assessed in primary care was 12 weeks (IQR 4-28 weeks). For 96 patients (57%) more than half of the overall delay in assessment in secondary care was accounted for by a delay in assessment in primary care.
  
  
  CONCLUSIONS
  Patient dependent factors, leading to a delay in consulting primary care physicians, are the principal reasons for the delay in patients with RA being seen by Rheumatologists in our population. A considerable body of evidence demonstrates that the earlier that therapy is introduced the better the clinical outcome. Consequently it is important to understand why some patients with RA delay in seeking medical advice, in order to allow effective interventions to reduce this delay.
authors.affiliation: Department of Rheumatology, Sandwell and West Birmingham Hospitals NHS Trust, The University of Birmingham, Birmingham B15 2TT, UK.
authors.forename: K
authors.initials: K
authors.lastname: Kumar
authors.forename: E
authors.initials: E
authors.lastname: Daley
authors.forename: D M
authors.initials: DM
authors.lastname: Carruthers
authors.forename: D
authors.initials: D
authors.lastname: Situnayake
authors.forename: C
authors.initials: C
authors.lastname: Gordon
authors.forename: K
authors.initials: K
authors.lastname: Grindulis
authors.forename: C D
authors.initials: CD
authors.lastname: Buckley
authors.forename: F
authors.initials: F
authors.lastname: Khattak
authors.forename: K
authors.initials: K
authors.lastname: Raza
mesh_terms: D000368:Aged; D001172:Arthritis, Rheumatoid / Q000175:diagnosis*; D042241:Early Diagnosis; D005194:Family Practice / Q000592:standards*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010044:Outpatient Clinics, Hospital; D010342:Patient Acceptance of Health Care; D011320:Primary Health Care / Q000592:standards; D012017:Referral and Consultation / Q000592:standards