Muller, SN ORCID: 0000-0001-6645-5751, Hider, S, Machin, A, Stack, R, Hayward, RA, Raza, K and Mallen, C (2018) Searching for a prodrome for rheumatoid arthritis in the primary care record: A case-control study in the Clinical Practice Research Datalink. Seminars in Arthritis and Rheumatism. ISSN 1532-866X

[img] Text
20180621_Text_numbered_refs_Muller_revision_v1.0_clean.pdf - Accepted Version
Restricted to Repository staff only until 23 June 2019.
Available under License Creative Commons Attribution Non-commercial No Derivatives.

Download (192kB)
[img] Text
Figure1_Muller.pdf - Supplemental Material
Restricted to Repository staff only until 23 June 2019.
Available under License Creative Commons Attribution Non-commercial No Derivatives.

Download (35kB)
[img] Text
Figure2_Muller.pdf - Supplemental Material
Restricted to Repository staff only until 23 June 2019.
Available under License Creative Commons Attribution Non-commercial No Derivatives.

Download (35kB)
[img] Text
20180621_Table1_Muller_revision.pdf - Supplemental Material
Restricted to Repository staff only until 23 June 2019.
Available under License Creative Commons Attribution Non-commercial No Derivatives.

Download (94kB)
[img] Text
20180621_muller_Supplementary tables.pdf - Supplemental Material
Restricted to Repository staff only until 23 June 2019.
Available under License Creative Commons Attribution Non-commercial No Derivatives.

Download (68kB)

Abstract

Background
Rheumatoid arthritis (RA) has articular and non-articular manifestations. Early, intensive treatment has substantial benefit for both. This requires patients be identified as soon as symptoms develop.

Objectives
To determine whether selected signs and symptoms can be identified in the primary care records of patients prior to a formal diagnosis of RA being made and, if so, how early they can be identified.

Methods
A case-control study was constructed within the UK Clinical Practice Research Datalink (CPRD). 3577 individuals with ‘definite’ RA, were matched to 14,287 individuals without inflammatory arthritis. An index date was established (i.e., date general practitioner (GP) first appeared to suspect RA). Rates of consultation and consultations for suspected early RA symptoms were compared in cases and controls in the two years prior to the index date using conditional logistic regression, adjusted for number of consultations.

Results
The mean (standard deviation) age of participants was 58.8 (14.5) years and 66.8% were female. Rates of any consultation were significantly higher in RA cases than in controls for at least two years prior to the index date. Cases were more likely to have a pre-diagnosis coded consultation for joint, and particularly hand symptoms (aOR 11.44 (9.60, 13.63)), morning stiffness (8.10 (3.54, 18.5)), carpal tunnel syndrome (4.57 (3.54, 5.88)) and other non-articular features.

Conclusions
In patients who develop RA, GP consultation rates are higher for at least two years prior to the first recorded suspicion of RA. This study highlights symptoms that should raise a GP's index of suspicion for RA.

Item Type: Article
Additional Information: This is the accepted author manuscript (AAM). The final published version (version of record) is available online via Elsevier at http://doi.org/10.1016/j.semarthrit.2018.06.008 - please refer to any applicable terms of use of the publisher.
Uncontrolled Keywords: rheumatoid arthritis, diagnosis, primary care
Subjects: R Medicine > RC Internal medicine > RC925 Diseases of the musculoskeletal system
Divisions: Faculty of Medicine and Health Sciences > Primary Care Health Sciences
Depositing User: Symplectic
Date Deposited: 21 Jun 2018 10:44
Last Modified: 27 Sep 2018 12:25
URI: http://eprints.keele.ac.uk/id/eprint/5039

Actions (login required)

View Item View Item