POS0434-HPR TIME FROM FIRST SYMPTOM EXPERIENCE TO FIRST GP CONTACT AMONG PATIENTS WITH RHEUMATOID ARTHRITIS: ASSOCIATIONS WITH COGNITIVE AND EMOTIONAL SYMPTOM REPRESENTATION
Authors: S. D. Pedersen, E. M. Hauge, M. Assmann, A. De Thurah
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> The prognosis of rheumatoid arthritis (RA) improves if treatment is initiated within 12 weeks of symptom onset, unfortunately, this window of opportunity is often missed due to different delays in the patient's journey from first symptom to treatment. The patient delay defined as time from symptom onset till help-seeking at the general practitioner (GP), has been shown as a major contributor to this diagnostic delay. Different somatic symptoms have been associated with length of patient delay; however, a person's help-seeking behavior is also influenced by psychological factors. The common-sense model of self-regulation (CSM)[1] suggests that patients construct illness representations, which are the beliefs and expectations about an illness or somatic symptom, that provides a basis for their coping response and help-seeking behavior. By focusing on psychological factors, we aim to provide epidemiological knowledge about the phase preceding first consultation at the GP, and hereby be able to reduce the patient delay in order to improve the prognosis. <h3>Objectives:</h3> To estimate the length of patient delay and examine the association between illness representations and time from first symptom onset to help-seeking at the GP. <h3>Methods:</h3> This is a cross-sectional study with patients ≥ 18 years old diagnosed with RA (ICD10: M05.3, M05.9, M05.8, M06) in Denmark 2021. Eligible patients were identified through the national database DANBIO and sent an invitation to complete a questionnaire. We assessed illness representations of the experienced symptoms by using The Revised Illness Perception Questionnaire (IPQ-R)[2] derived from the CSM. IPQ-R consists of four domains: Identity (perception of the symptom), timeline (perceived duration), consequences (anticipated consequences) and personal control, treatment control (perceptions of whether the disease can be controlled/cured). Identity was assessed by listing 15 symptoms commonly experienced in the early phase of RA, and was divided into symptoms believed to be related to RA or not. Other subscales consisted of three to six questions each rated on a 5-point Likert scale: strongly disagree, disagree, neither agree nor disagree, agree, and strongly agree. For each subscale the patients composite score was calculated, and the participants were divided into three groups: low (the 25% with the lowest score), middle (the 50% in the middle), and high (the 25% with the highest score. Within each subscale multivariable linear regression was used to estimate the median ratio (MR) with 95 % confidence interval (95% CI) of patient delay with the low group as a reference. Potential confounders were identified a priori and analyses were adjusted for sex, age, education, cohabiting, and numbers of visit to the GP not related to the symptom the year preceding diagnosis. <h3>Results:</h3> We included 404 patients. The median patient delay was 63 days (IQR 17-214). The patient delay in the group with highest score in consequence was significantly associated with shorter median patient delay compared to the groups with the lowest score (MRadjusted=0.49, 95% CI: 0.27-0.89) (Figure 1), indicating that median patient delay was typically 51% lower among those experiencing or anticipating high consequences. Compared to the low group, the high group in treatment control (MRadjusted 0.54, 95%CI: 0.29-0.99) and emotional representations (MRadjusted 0.55, 95% CI: 0.31-0.98) also had significantly shorter median patient delay. <h3>Conclusion:</h3> Patients who experienced high emotional distress, anticipated or experienced consequences of their symptom, or believed their symptom could be treated had a shorter median patient delay. With a median patient delay of 63 days, this study underscores the significance of reducing this aspect of the overall diagnostic delay and proposes potential focal points for upcoming public information campaigns and intervention development. <h3>REFERENCES:</h3> [1] Leventhal H et al. J Behav Med. 2016. [2] Moss-Morris R et al. Psychol Health. 2002. <h3>Acknowledgements:</h3> We would like to thank the participants in the study, DANBIO for providing data, and The Danish Rheumatism Association for financial support. <h3>Disclosure of Interests:</h3> <b>None declared.</b>