Objectives Timely treatment of patients with Early Rheumatoid Arthritis (ERA) favors a beneficial disease outcome. However, individuals often delay their contact with a healthcare professional (HCP) after ERA-related symptom onset. This study investigates the patients’ perspective on the patient’s journey from RA symptom onset until referral to a specialist. Methods A subgroup of patients with ERA from the Care in ERA (CareRA) trial were retrospectively interviewed to discuss their initial ERA-related experiences preceding diagnosis, using a bespoke assessment form. The form’s first section focused on initial symptoms and patients’ help-seeking behavior. The second part probed the consulted HCPs’ actions. Additional notes derived from the patient stories were thematically analyzed. Results Among 94 patients, pain (97%), swelling (73%) and stiffness (52%), typically in multiple joints, were reported as initial ERA-symptoms. The general practitioner (GP) was generally the first contacted HCP (87%). Frequently reported reasons to visit a HCP were too intense pain (90.4%) and difficulties in performing daily activities (69%). In 44.1% of patients, the HCP suspected ERA at the first visit. Approximately 25% of patients needed >5 visits before ERA detection. GPs mainly referred patients to rheumatologists (71%). Thematic analysis uncovered that often multiple HCPs were involved in the journey to RA detection and referral. Conclusion Pain is the most commonly reported initial symptom of ERA and the main reason to visit a HCP, mostly a GP. These GPs play a pivotal role in early detection and correct referral. Furthermore, the patient’s journey seems complex with often multiple HCPs involved.

BackgroundAfter symptom onset, persons later on diagnosed with Early Rheumatoid Arthritis (ERA), often delay their contact with a health care professional (HCP). Moreover, some HCPs do not feel confident in ERA detection1. Therefore, a better understanding of patients' perception of the first symptoms of RA and their interaction with HCPs could aid in decreasing treatment delay in ERA.ObjectivesTo investigate in detail the help-seeking trajectory in patients with ERA from symptom onset until referral to a rheumatologist.MethodsIn the present cross-sectional study, 94 DMARD-naive patients with ERA enrolled in the CareRA trial were included. Participants were recruited in 1 academic center. During a clinical visit, they were questioned about initial ERA-related experiences using a self-developed assessment form. The first part of the form focused on patients' perception of initial symptoms and their help-seeking behavior, including the nature of first symptoms, concurrent events at symptom onset, the first HCP visited and the reasons for consulting a HCP. The second part emphasized the actions undertaken by the consulted HCP until referral, including the detection procedure leading to recognition of initial symptoms as ERA-related, other disorders considered and the number of visits before ERA was detected.ResultsOf the 94 participants, mean ± SD age was 52±14 years, 75% were women, 62% were RF positive and 73% ACPA positive. As first ERA symptoms, patients reported joint pain (97%), limited joint mobility (42%) and joint swelling (73%), typically in multiple joints. Other symptoms experienced were fatigue (21%) and morning stiffness (33%). Eight patients described loss of strength or redness in the affected joints. Physical overburdening or emotional stress was stated by 14 patients as concurrent event at symptom onset. Generally, the general practitioner (GP) was the first contacted HCP (86%). The most frequently reported reasons to visit a HCP were too much pain (90%), prominent swelling (33%) and difficulties in performing daily activities (69%). In 42% of the patients, the HCP suspected the symptoms to be ERA-related. Before ERA was detected, 26% of the patients required 1 visit, 22% needed 2 visits, 13% needed 3 visits, 7% needed 4 visits, 7% needed 5 visits and 25% needed >5 visits. According to the patients, local inflammation (23%) and muscular conditions (21%) were considered as the most likely diagnosis by the HCP. A blood test was performed in 73% and pain medication was prescribed in 57% of the patients before referral. The HCP mainly referred patients to a rheumatologist (71%) and less frequently to other specialists, such as an orthopedic surgeon (10%).ConclusionsPain is the foremost remembered ERA-related symptom at onset and the most important reason to visit a HCP, mostly the GP. Furthermore, 25% of patients needed >5 visits before ERA was detected. There are opportunities to make ERA detection more efficient and decrease treatment delay.ReferencesMeyfroidt S, Stevens J, De Lepeleire J, Westhovens ...

Objectives:The aim of the present study is to develop relevant quality indicators (QI) to monitor and improve quality of care in vascular surgery. Methods:The Delphi method was used to incorporate expert opinion to reach consensus on a set of QI.A national expert panel consisting of 52 vascular surgeons was installed on a voluntary basis and endorsed by the Belgian Society of Vascular Surgery and the Flemish Hospital Network KU Leuven. A task force team consisting of 12 surgeons was created to serve as a delegation of the expert panel to discuss and filter the obtained data from the different Delphi rounds.Results: A total of three Delphi rounds were needed to reach consensus on a set of 20 QI. Each QI had a content validity index (using a 7-point Likert scale), a feasibility index and a target level. Twelve outcome indicators and eight process indicators on several vascular topics were selected: overall for all vascular treatments (n=1), arterial occlusive disease in general (n=3), arterial occlusive disease of the lower limbs (n=4), arterial occlusive disease of the carotid arteries (n=5), arterial aneurysm disease in general (n=2), arterial aneurysm disease with endovascular treatment (n=1) and venous disease (n=4). Conclusions:This resulted in the successful identification of 20 validated and relevant vascular QI, focusing on arterial occlusive disease, arterial aneurysm disease and venous disease. The next step in this project will be the performance of an implementation study.

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