Observational studyBMJ open2019
Delays between the onset of symptoms and first rheumatology consultation in patients with rheumatoid arthritis in the UK: an observational study.
Observational study in BMJ open, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 51 papers, 3 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
51 citing papers in PubMed, 3 syntheses or guidelines pooled it.
- Rheumatoid Arthritis referral criteria: systematic review of the literature.BMC rheumatology · 2026Pooled it
- Mediterranean diet and rheumatoid arthritis: A nine-year cohort study and systematic review with meta-analysis.European journal of clinical nutrition · 2025Pooled it
- Diagnostic Delay in Pediatric Inflammatory Bowel Disease: A Systematic Review.Digestive diseases and sciences · 2022Pooled it
- RhePort 1.3 enhances early identification of inflammatory rheumatic diseases: a prospective study in German rheumatology settings.Rheumatology international · 2025Trial
- Accuracy, patient-perceived usability, and acceptance of two symptom checkers (Ada and Rheport) in rheumatology: interim results from a randomized controlled crossover trial.Arthritis research & therapy · 2021Trial
- Machine learning improves online self-referral for inflammatory rheumatic diseases: a registry-based validation study.Rheumatology international · 2026Article
- Sex and gender differences in rheumatology: clinical impact and future directions.Nature reviews. Rheumatology · 2026Review
- Perspectives and Needs Regarding Remote Monitoring Technologies Among South Asian Individuals Living With Long-Term Conditions in the United Kingdom: Semistructured Interview and Focus Group Study.JMIR human factors · 2026Article
- A deep learning system for diagnosis of rheumatoid arthritis on digital hand photographs.BMC rheumatology · 2026Article
- Open-access clinic for arthralgia: patient flow and diagnostic pathways-a retrospective cohort study.EULAR rheumatology open · 2026Article
- Article
- Targeted anti-CCP testing to identify people at risk of rheumatoid arthritis in primary care: an early economic evaluation.Rheumatology advances in practice · 2026Article
- Evaluating the Accuracy of the Frysian Questionnaire for Differentiation of Musculoskeletal Complaints for Triage of Musculoskeletal Diseases: Algorithm Development and Validation Study.JMIR medical informatics · 2025Article
- Management and treatment of early rheumatoid arthritis, process and barriers among rheumatologists in Spain: a Delphi consensus.BMC rheumatology · 2025Article
- Identifying people at risk of rheumatoid arthritis in primary care: a qualitative study.The British journal of general practice : the journal of the Royal College of General Practitioners · 2025Article
- Rheumatic? A diagnostic decision support tool for individuals suspecting rheumatic diseases: Mixed-methods usability and acceptability study.BMC rheumatology · 2025Article
- Trajectories of physical, mental health and health satisfaction before and after arthritis diagnosis: a UK population-based study.BMC musculoskeletal disorders · 2025Article
- Prodromal symptoms of rheumatoid arthritis in a primary care database: variation by ethnicity and socioeconomic status.Rheumatology (Oxford, England) · 2025Article
- Development and Validation of a Cost-Effective Machine Learning Model for Screening Potential Rheumatoid Arthritis in Primary Healthcare Clinics.Journal of inflammation research · 2025Article
- The global health and economic burden of chikungunya from 2011 to 2020: a model-driven analysis on the impact of an emerging vector-borne disease.BMJ global health · 2024Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
11 authors.
Funding
Abstract
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.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.