Dr. Stack and Ms Sahni contributed equally to this work.
Symptom Complexes at the Earliest Phases of Rheumatoid Arthritis: A Synthesis of the Qualitative Literature†
Article first published online: 27 NOV 2013
© 2013 The Authors. Arthritis Care & Research is published by Wiley Periodicals, Inc. on behalf of the American College of Rheumatology.
This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
Arthritis Care & Research
Volume 65, Issue 12, pages 1916–1926, December 2013
How to Cite
Stack, R. J., Sahni, M., Mallen, C. D. and Raza, K. (2013), Symptom Complexes at the Earliest Phases of Rheumatoid Arthritis: A Synthesis of the Qualitative Literature. Arthritis Care Res, 65: 1916–1926. doi: 10.1002/acr.22097
The views expressed in this publication are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health.
- Issue published online: 27 NOV 2013
- Article first published online: 27 NOV 2013
- Accepted manuscript online: 7 AUG 2013 12:51PM EST
- Manuscript Accepted: 30 JUL 2013
- Manuscript Received: 16 JAN 2013
- NIHR under the Research for Patient Benefit Programme. Grant Number: Funder's reference PB-PG-1208-18114
- Arthritis Research UK Clinician Scientist Award
Understanding the features and patterns of symptoms that characterize the earliest stages of rheumatoid arthritis (RA) is of considerable importance if patients are to be identified and started on treatment early. However, little is known about the characteristics of symptoms at the onset of a disease that eventually progresses to RA.
A systematic review of qualitative peer-reviewed publications was conducted to identify the earliest symptoms associated with the onset of RA. A total of 1,736 abstracts were searched to identify relevant publications. Twenty-six publications were identified, assessed for quality, and subjected to analysis informed by thematic and grounded theory frameworks.
Several interacting themes describing the early symptoms of RA were identified, including swelling, pain and tenderness, stiffness, fatigue and weakness, and the emotional impact of symptoms. For each symptom, different and evolving intensities were described; in some cases, patterns of symptom onset and symptom complexes at the onset of RA were highlighted. Importantly, this review has emphasized major deficiencies in the literature. None of the studies reviewed originally aimed to explore symptoms at RA onset (often discussions about symptom onset were secondary to the study's primary aim). Also, many of the articles identified sampled people diagnosed with RA many years previously, making their recollection of symptoms at onset less reliable.
In order for clinicians to fully understand the earliest phases of disease, the nature of symptoms at onset needs to be understood. The current work represents a useful starting point, but this area needs further qualitative investigation, followed by quantitative explorations of symptom clusters and their associated features.