Background/Purpose: To achieve better prediction of the development of rheumatoid arthritis (RA) a EULAR study group recommended identification and assessment of symptoms in those with arthralgia and during the earliest phases of clinical arthritis as a research priority.The aim of this study was to explore early symptom experiences in individuals with arthralgia at risk of RA and in individuals with new onset RA.

Methods: Focus groups with fifteen arthralgia patients (positive anti-CCP) and in-depth interviews with eleven newly presenting RA patients (2010 criteria) were conducted. An active feedback procedure was used to share experiences of arthralgia patients with early RA patients and vice versa. When saturation was reached transcripts were analysed using thematic analysis and major themes were identified. The analyses were merged to explore similarities and differences in themes between groups.

Results: Themes common to arthralgia and early RA patients included: pain (described in the joints and also in muscles and tendons); tingling sensations; loss of strength and weakness; fatigue and sleeping difficulties; self-reported swelling, redness and warmth; joint stiffness and intermittent symptoms. However, some differences were noted. Arthralgia patients described pain that was often concentrated in their hands and feet as bothersome and annoying. Early RA patients described pain that had intensified to excruciating levels before diagnosis; in some cases pain was likened to a broken bone. Arthralgia patients reported short episodes of intermittent swelling which often involved feelings of pain and fatigue. RA patients recalled that changes in their experience of swelling marked a significant change in the course of their illness, with the nature and pattern of swelling (such as intensification, development of symmetry, translocation) changing shortly before being diagnosed. Such changes were reported to be triggers for patient consultation and physician referral. Fatigue and sleeping difficulties were a dominant problem for arthralgia patients, they noted intense and troubling pain at night. RA patients also reported that night pain was one of the first symptoms they recalled. 

Conclusion: Understanding the features and patterns of symptoms characterising the earliest stages of RA is important if patients are to be identified and started on treatment early. Arthralgia and early RA patients shared symptoms which characterised the onset of disease, however, this detailed exploration of symptoms highlighted how the intensity (e.g. pain), and the pattern (e.g. changes in the pattern of swelling) differ between the two groups. Further research to develop measures of symptom patterns and clusters which occur in arthralgia patients and may signal the emergence of RA is required. This research should be followed by quantitative explorations of symptom clusters and their associated features.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/symptom-complexes-at-the-beginning-of-rheumatoid-arthritis-a-qualitative-exploration-in-at-risk-individuals-and-in-new-patients-prior-to-diagnosis/