title: Symptom complexes in patients with seropositive arthralgia and in patients newly diagnosed with rheumatoid arthritis: a qualitative exploration of symptom development.
abstract: OBJECTIVE
  The aim of this study was to explore symptoms and symptom development during the earliest phases of RA in patients with seropositive arthralgia and patients newly diagnosed with RA.
  
  
  METHODS
  Interviews were conducted with 15 seropositive patients (anti-CCP positive, and often with arthralgia) and 11 newly presenting RA patients [classified according to the 2010 ACR/European League Against Rheumatism (EULAR) criteria]. Feedback procedures shared the experiences of seropositive arthralgia patients with early RA patients and vice versa. Data were analysed using thematic analysis.
  
  
  RESULTS
  Symptoms common to both groups included joint pain, psychological distress, muscle cramps, abnormal skin sensations, stiffness, loss of motor control, weakness, fatigue and sleeping difficulties. Also, patterns of symptom evolution and the order of symptom development were described. Seropositive arthralgia patients described pain as annoying, while RA patients described how the severity of pain intensified before diagnosis, to the point where symptoms were psychologically distressing. Patients with seropositive arthralgia described reddening of the skin and burning sensations that they felt were indicative of the onset of swelling. Intense pain appeared to precede the onset of swelling for those with RA, which was often palindromic and travelled between joints until it later became persistent.
  
  
  CONCLUSIONS
  This study highlights the breadth of symptoms that constitute the earliest phases of RA. Further research is needed to develop measures of symptom patterns and clusters to allow the predictive utility of symptoms to be assessed and to allow the integration of aspects of the patient's history into evidence-based investigative and management algorithms for use in primary and secondary care.
authors.affiliation: Centre for Translational Inflammation Research, University of Birmingham, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK, Department of Rheumatology, VU University Medical Center, Jan van Breemen Research Institute | Reade, Amsterdam, The Netherlands and Arthritis Research UK Primary Care Centre, University of Keele, Stoke-on-Trent, UK.Centre for Translational Inflammation Research, University of Birmingham, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK, Department of Rheumatology, VU University Medical Center, Jan van Breemen Research Institute | Reade, Amsterdam, The Netherlands and Arthritis Research UK Primary Care Centre, University of Keele, Stoke-on-Trent, UK.
authors.forename: Rebecca J
authors.initials: RJ
authors.lastname: Stack
authors.affiliation: Centre for Translational Inflammation Research, University of Birmingham, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK, Department of Rheumatology, VU University Medical Center, Jan van Breemen Research Institute | Reade, Amsterdam, The Netherlands and Arthritis Research UK Primary Care Centre, University of Keele, Stoke-on-Trent, UK. L.vantuyl@vumc.nl.
authors.forename: Lilian H D
authors.initials: LH
authors.lastname: van Tuyl
authors.affiliation: Centre for Translational Inflammation Research, University of Birmingham, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK, Department of Rheumatology, VU University Medical Center, Jan van Breemen Research Institute | Reade, Amsterdam, The Netherlands and Arthritis Research UK Primary Care Centre, University of Keele, Stoke-on-Trent, UK.
authors.forename: Maurits
authors.initials: M
authors.lastname: Sloots
authors.affiliation: Centre for Translational Inflammation Research, University of Birmingham, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK, Department of Rheumatology, VU University Medical Center, Jan van Breemen Research Institute | Reade, Amsterdam, The Netherlands and Arthritis Research UK Primary Care Centre, University of Keele, Stoke-on-Trent, UK.
authors.forename: Lotte A
authors.initials: LA
authors.lastname: van de Stadt
authors.affiliation: Centre for Translational Inflammation Research, University of Birmingham, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK, Department of Rheumatology, VU University Medical Center, Jan van Breemen Research Institute | Reade, Amsterdam, The Netherlands and Arthritis Research UK Primary Care Centre, University of Keele, Stoke-on-Trent, UK.
authors.forename: Wijnanda
authors.initials: W
authors.lastname: Hoogland
authors.affiliation: Centre for Translational Inflammation Research, University of Birmingham, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK, Department of Rheumatology, VU University Medical Center, Jan van Breemen Research Institute | Reade, Amsterdam, The Netherlands and Arthritis Research UK Primary Care Centre, University of Keele, Stoke-on-Trent, UK.
authors.forename: Bertha
authors.initials: B
authors.lastname: Maat
authors.affiliation: Centre for Translational Inflammation Research, University of Birmingham, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK, Department of Rheumatology, VU University Medical Center, Jan van Breemen Research Institute | Reade, Amsterdam, The Netherlands and Arthritis Research UK Primary Care Centre, University of Keele, Stoke-on-Trent, UK.
authors.forename: Christian D
authors.initials: CD
authors.lastname: Mallen
authors.affiliation: Centre for Translational Inflammation Research, University of Birmingham, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK, Department of Rheumatology, VU University Medical Center, Jan van Breemen Research Institute | Reade, Amsterdam, The Netherlands and Arthritis Research UK Primary Care Centre, University of Keele, Stoke-on-Trent, UK.Centre for Translational Inflammation Research, University of Birmingham, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK, Department of Rheumatology, VU University Medical Center, Jan van Breemen Research Institute | Reade, Amsterdam, The Netherlands and Arthritis Research UK Primary Care Centre, University of Keele, Stoke-on-Trent, UK.
authors.forename: Rumandeep
authors.initials: R
authors.lastname: Tiwana
authors.affiliation: Centre for Translational Inflammation Research, University of Birmingham, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK, Department of Rheumatology, VU University Medical Center, Jan van Breemen Research Institute | Reade, Amsterdam, The Netherlands and Arthritis Research UK Primary Care Centre, University of Keele, Stoke-on-Trent, UK.Centre for Translational Inflammation Research, University of Birmingham, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK, Department of Rheumatology, VU University Medical Center, Jan van Breemen Research Institute | Reade, Amsterdam, The Netherlands and Arthritis Research UK Primary Care Centre, University of Keele, Stoke-on-Trent, UK.
authors.forename: Karim
authors.initials: K
authors.lastname: Raza
authors.affiliation: Centre for Translational Inflammation Research, University of Birmingham, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK, Department of Rheumatology, VU University Medical Center, Jan van Breemen Research Institute | Reade, Amsterdam, The Netherlands and Arthritis Research UK Primary Care Centre, University of Keele, Stoke-on-Trent, UK.Centre for Translational Inflammation Research, University of Birmingham, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK, Department of Rheumatology, VU University Medical Center, Jan van Breemen Research Institute | Reade, Amsterdam, The Netherlands and Arthritis Research UK Primary Care Centre, University of Keele, Stoke-on-Trent, UK.
authors.forename: Dirkjan
authors.initials: D
authors.lastname: van Schaardenburg
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018771:Arthralgia / Q000150:complications / Q000175:diagnosis* / Q000523:psychology; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000175:diagnosis* / Q000523:psychology; D001294:Attitude to Health; D015415:Biomarkers / Q000097:blood; D018450:Disease Progression; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000209:etiology / Q000523:psychology; D010456:Peptides, Cyclic / Q000097:blood; D036301:Qualitative Research; D012720:Severity of Illness Index; D013315:Stress, Psychological / Q000209:etiology / Q000523:psychology
chemical_list: D015415:Biomarkers; D010456:Peptides, Cyclic; C487763:cyclic citrullinated peptide
keywords: arthralgia; early arthritis; qualitative; rheumatoid arthritis; symptom complex; symptom experience