Number Of Misdiagnoses Research Articles

Patient Experiences and Challenges in the Management of Autoinflammatory Diseases-Data from the International FMF & AID Global Association Survey.

Autoinflammatory diseases (AIDs) are rare, mostly genetic diseases that affect the innate immune system and are associated with inflammatory symptoms. Both paediatric and adult patients face daily challenges related to their disease, diagnosis and subsequent treatment. For this reason, a survey was developed in collaboration between the FMF & AID Global Association and the Erlangen Center for Periodic Systemic Autoinflammatory Diseases. The aim of the survey was to collect the personal assessment of affected patients with regard to their current status in terms of diagnostic timeframes, the interpretation of genetic tests, the number of misdiagnoses, and pain and fatigue despite treatment. In total, data from 1043 AID patients (829 adults and 214 children/adolescents) from 52 countries were collected and analyzed. Familial Mediterranean fever (FMF) (521/50%) and Behçet's disease (311/30%) were the most frequently reported diseases. The average time to diagnosis was 3 years for children/adolescents and 14 years for adults. Prior to the diagnosis of autoinflammatory disease, patients received several misdiagnoses, including psychosomatic disorders. The vast majority of patients reported that genetic testing was available (92%), but only 69% were tested. A total of 217 patients reported that no increase in acute-phase reactants was detected during their disease episodes. The intensity of pain and fatigue was measured in AID patients and found to be high. A total of 88% of respondents received treatment again, while 8% reported no treatment. AID patients, particularly adults, suffer from significant delays in diagnosis, misdiagnosis, and a variety of symptoms, including pain and fatigue. Based on the results presented, raising awareness of these diseases in the wider medical community is crucial to improving patient care and quality of life.

Routine use of ultrasound imaging to diagnose skier’s thumb. Results from a first-aid orthopedic department in an Italian ski resort

Damage to the ulnar collateral ligament (UCL) of the thumb’s metacarpophalangeal joint (TMPJ) can result in severe functional impairment: correct diagnosis is critical to ensure the appropriate treatment to restore full TMPJ function. In an acute phase, clinical findings and X-rays alone are not reliable enough for a precise diagnosis: ultrasound scan (USS) may represent a fast, inexpensive and sensitive technique to improve the diagnosis of thumb trauma in emergency department. The purpose of this study is to assess if the introduction of the routine use of USS in clinical practice to evaluate thumb trauma could aid in diagnosis and treatment of this common injury. During eight winter seasons (2012-19), we dealt with 2553 injuries of the TMCJ at our emergency department. During the first period (2012-2015), the diagnosis of TMCJ injuries relied on clinical examination and X-rays; in the second study period (2016-2019) the diagnosis of all thumb traumas were based on clinical examination, radiographs, and ultrasound. Patients affected by type I and II lesions were conservatively treated by the application of a thumb spica plaster for three weeks, while in type III injuries for a period of one month. Type IV UCL lesions underwent surgery through a phalanx tunneling and anchor fixation technique followed by 5-weeks of immobilization in a thumb spica plaster cast. Both groups were followed up either clinically or as phone consultations for foreign patients. In the period 2012-2015, we classified 27% of TMPJ lesions as type I, 19% as type II, 15% as type III, and 27% as type IV lesions. The remaining 12% represented a fracture variant (type V). USS identified 30% type I, 21% type II, 18% type III, and 19% type IV lesions, the latter with a positive so called tadpole sign (14) (247 pts.); the remaining 12% of patients presented a fracture variant. During the first study period, the diagnosis of TMPJ injuries made exclusively by clinical examination and X-ray studies, lead to a high number of false positive type IV diagnoses that were not confirmed during surgery (13%). The introduction of USS imaging during the second period led to a detection of almost all (> 98%) type IV lesions intra-operatively, thereby avoiding unnecessary surgery, possible complications, rehabilitation, and recovery. Our work demonstrates that the routine use of USS imaging in the study of thumb UCL injuries improves the diagnostic sensitivity of clinical findings in a low cost, quick and feasible manner. USS can lead to a significant decrease in the number of misdiagnoses as previously demonstrated by other studies. USS is likely to improve patient collaboration and could potentially supplant stress-test radiography which can be painful and potentially risky in some patients.

Using decision-analysis modelling to estimate the economic impact of the identification of unrecognised bipolar disorder in primary care: the untapped potential of screening

BackgroundPatients with bipolar disorder are often unrecognised and misdiagnosed with major depressive disorder leading to higher direct costs and pressure on the medical system. Novel screening tools may mitigate the problem. This study was aimed at investigating the direct costs of bipolar disorder misdiagnosis in the general population, evaluating the impact of a novel bipolar disorder screening algorithm, and comparing it to the established Mood Disorder Questionnaire. A decision analysis model was built to quantify the utility of one-time screening for bipolar disorder in primary care adults presenting with a depressive episode. A hypothetical population of interest comprised a healthcare system of one million users, corresponding to 15,000 help-seekers diagnosed with major depressive disorder annually, followed for five years. The model was used to calculate the impact of screening for bipolar disorder, compared to no screening, in terms of accuracy and total direct costs to a third-party payer at varying diagnostic cut-offs. Decision curve analysis was used to evaluate clinical utility.ResultsCompared to no screening, one-time screening for bipolar disorder using the algorithm reduced the number of misdiagnoses from 680 to 260, and overall direct costs from $50,936 to $49,513 per patient, accounting for $21.3 million savings over the five-year period. The algorithm outperformed the Mood Disorder Questionnaire, which yielded 367 misdiagnoses and $18.3 million savings over the same time. Decision curve analysis showed the screening model was beneficial.ConclusionsUtilisation of bipolar disorder screening strategies could lead to a substantial reduction in human suffering by reducing misdiagnosis, and also lessen the healthcare costs.

Survey on the Influence of Living Environment Factors on Diagnosis of Idiopathic Pulmonary Fibrosis in Foshan

Purpose of the study: (a) investigate the relationship between the time and diagnosis of IPF and its influencing factors, (b) provide information from patients' real-life diagnostic experiences for the development of more rational diagnostic pathways and the introduction of more treatment options and technologies, and (c) improve the publics’ awareness of IPF and promote the prevention of IPF.
 Methods of investigation: A questionnaire was designed to survey 37 patients with IPF in January 2022, including general information questionnaires and age, sex, time for diagnosis, etc. Ridge regression analysis was used to explore the factors influencing the length and difficulty of IPF diagnosis. In addition, 11 respiratory physicians were interviewed by online interview about the difficulty of IPF diagnosis, treatment options, and patient prognosis.
 Results: The stress caused by the lack of formal diagnosis (B=0.617, p<0.001), the high cost of the diagnosis process (B=0.509, p<0.001), and the number of misdiagnoses or missed diagnoses (B=0.177, p<0.005) were significantly related to the length and difficulty of the IPF diagnosis (p<0.05).
 Conclusions: The findings highlight the need for new appropriate, convenient, and economical diagnostic procedures to be developed and designed. Simultaneously, professionals should strengthen the dissemination of disease understanding among the susceptible population, improve understanding and attention to the patients' condition, and conduct more lectures on the basics of avoiding IPF to strengthen the knowledge, which can effectively improve the mental quality of the susceptible population, in conjunction with the advice given by the doctors in the interviews.

Problems of primary fallopian tube cancer diagnostics during and after surgery

To date, the reliable diagnoses primary fallopian tube cancer (PFTC) before surgery range from 0% to 10–15%. Number of misdiagnosis even during operations reaches 30–50% and PFTC is often disguised as innocent hydro-hematosalpinx or other diseases.Research objective: to study the possibilities of PFTC diagnosis during laparotomy and laparoscopy, macroscopic examination of removed macrodrugs, suboperative use of morphological studies, problems of histological interpretation of PFTC after surgery.Materials and methods. During the period from 1966 to 2020 authors of article selected and retrospectively studied quite informative medical histories of 105 patients with PFTC aged 34 to 78 years (mean age 55.8 years). All patients were operated. Revision of the pelvic organs and abdominal cavity was performed during operations. Removed macrodrugs were examined macroscopically and histologically. According to the indications during operations histological and cytological methods of rapid diagnosis were used. Immunohistochemical methods were used to interpret rare and difficult to diagnose tumors after surgery.Results. Only 7 (6.6%) from 105 patients with PFTC was not recognized during surgery, and 18 (17.1%) were diagnosed only after suboperative histological examination. Errors during operations in the initial PFTC forms (without careful study of macrodrugs and suboperative morphological examination) can reach 23.8%. Problems with the primary lession interpretation, which arose in 11 (10.5%) patients with a pronounced tumor process, did not prevent the choice of adequate surgery. The tumor dissemination of the fallopian tube outside was detected in 69 (72.4%) patients, in 25 (26.2%) among them there were lymph node metastases.Conclusion. Careful revision of the abdominal organs and macroscopic examination of removed drugs using suboperative morphological studies avoids errors in the diagnosis and surgical treatment of patients with PFTC.

Rapid brain structure and tumour margin detection on whole frozen tissue sections by fast multiphotometric mid-infrared scanning

Frozen section analysis is a frequently used method for examination of tissue samples, especially for tumour detection. In the majority of cases, the aim is to identify characteristic tissue morphologies or tumour margins. Depending on the type of tissue, a high number of misdiagnoses are associated with this process. In this work, a fast spectroscopic measurement device and workflow was developed that significantly improves the speed of whole frozen tissue section analyses and provides sufficient information to visualize tissue structures and tumour margins, dependent on their lipid and protein molecular vibrations. That optical and non-destructive method is based on selected wavenumbers in the mid-infrared (MIR) range. We present a measuring system that substantially outperforms a commercially available Fourier Transform Infrared (FT-IR) Imaging system, since it enables acquisition of reduced spectral information at a scan field of 1 cm2 in 3 s, with a spatial resolution of 20 µm. This allows fast visualization of segmented structure areas with little computational effort. For the first time, this multiphotometric MIR system is applied to biomedical tissue sections. We are referencing our novel MIR scanner on cryopreserved murine sagittal and coronal brain sections, especially focusing on the hippocampus, and show its usability for rapid identification of primary hepatocellular carcinoma (HCC) in mouse liver.

Effect of Addition of WZB117 as an Inhibitor of Glucose Transporter 1 for Venous Blood Glucose Determination.

Sodium fluoride (NaF) has been applied to inhibit glycolysis in venous specimens for decades. However, it has had little effect on the rate of glycolysis in the first 1 to 2 hours, resulting in a decrease of glucose, so a more efficient method is needed. Recently, we discovered that WZB117, a specific Glut1 inhibitor, restricts glycolysis by inhibiting the passive sugar transport of human red blood cells and cancer cells. The purpose of this study was to evaluate the results of intravenous blood glucose determination after the addition of WZB117. Venous specimens from 40 pairs of healthy volunteers were collected for several days and placed in tubes containing NaF plus EDTA-disodium (Na2) without WZB117 (the A group); citric acid, trisodium citrate, and EDTA-Na2 without WZB117 (B group); and NaF plus EDTA-Na2 with WZB117 (C group). The glucose concentration was measured after venipuncture and compared with test tubes treated for 1 hour, 2 hours, and 3 hours before centrifugation. Glucose level was determined by the hexokinase method. The paired t-test was used to examine differences in glucose values at baseline and at different time points. The number of misdiagnoses and the misdiagnosis rate were calculated at 2 diagnostic stages: high risk of diabetes (glucose level of 6.1 mmol/L) and diagnosis of diabetes (glucose level of 7.0 mmol/L). Glucose levels decreased by 1.0% at 1 hour and by 2.1% at 3 hours in the C group tubes and simultaneously decreased by 1.7% at 1 hour and by 2.5% at 3 hours in the B group tubes. In contrast, glucose levels decreased by 4.1% at 1 hour and by 6.3% at 3 hours in the A group tubes. There was a statistically significant difference in glucose levels measured in the A group tubes and B group tubes at 1 hour, 2 hours, and 3 hours. The misdiagnosis rate of clinical diagnosis in diabetes was highest in the A group tubes (7.0‰ at 1 hour, 0.1‰ at 3 hours at 7.0 mmol/L point; 14.6‰ at 1 hour, 0.4‰ at 3 hours at 6.1 mmol/L point) and lowest in the C group tubes (2.95‰ at 1 hour, 0‰ at 3 hours at 7.0 mmol/L point; 4.8‰ at 1 hour, 0.1‰ at 3 hours at 6.1 mmol/L point). The tube addition of WZB117 is more suitable for minimizing glycolysis and has no effect on glucose levels even if specimens are left uncentrifuged for up to 3 hours.

COMPARATIVE ANALYSIS OF MORPHOLOGICAL CRITERIA FOR DIFFERENTIAL DIAGNOSTICS OF WIDE QRS COMPLEX ARRHYTHMIAS WITH LEFT BUNDLE BRANCH BLOCK MORPHOLOGY

Introduction. Determination of ventricular and supraventricular arrhythmias with left bundle branch block morphology (LBBB) seems to be one of the most complex diagnostic tasks when P waves are not clearly identifiable on 12-lead ECG. Previously described criteria for differential diagnosis of wide QRS arrhythmias had low accuracy especially for patients from various clinical groups and also those taking antiarrhythmic drugs. When patient’s clinical data, medical history or physical examination results are not available the number of misdiagnosis may increase leading to improper treatment. Therefore, development of new temporal and amplitude based characteristics of wide QRS complex arrhythmias with LBBB morphology in patients of any clinical groups is an important task.Methods. Twenty-eight consecutive patients with wide QRS premature beats and LBBB morphology identified by 24-hour and long-term ECG monitoring (ZAO “INCART”, Russia) were enrolled in the study. Fourteen patients had premature atrial contractions (PAC) and fourteen patients had premature ventricular contractions (PVC) during sinus rhythm. For each patient 10 typical single wide QRS complexes in 12 ECG leads were analyzed. The duration of QRS complexes, time intrinsic deflection (TID) and electrical axis of the heart were determined automatically in 12 leads ECG using KT Result 3 software (ZAO “INCART”, Russia). The experts assessed morphology of the QRS complexes and transition zone location in leads V1-V6. ROC analysis with optimal cut-off value level evaluation as well as calculation of sensitivity (SV), specificity (SP) and diagnostic accuracy (ACC) were performed for qualitative and quantitative assessment of diagnostic value of PAC and PVC amplitude and temporal characteristics. Comparison of diagnostic values of wide QRS complex morphological and temporal criteria was performed based on the AUC difference and the corresponding p-value assessment.Results. The results of study found out that V5, V1 leads were more informative for assessment of QRS complex morphology and duration while V1 and V4 leads were more informative for TID calculation in differential diagnosis of wide QRS complexes arrhythmias with LBBB morphology. PAC with aberrant conduction had the following characteristics: TID < 68 ms in V1 lead and TID < 62 ms in V4 lead; QRS < 136 ms; transition zone in the leads V5, V6; QS, rS or RS complexes (with S> R) with low-amplitude r/R waves in leads V1-V4; electric axis of the heart less than 80° in standard leads. In all cases PVCs were characterized by QRS > 160 ms and TID > 88 ms in V1-V6 leads.Conclusions. New various criteria which can improve differential diagnosis of wide QRS complexes with LBBB morphology were identified in this study. These criteria should be tested in a larger group of patients with various forms of wide QRS complex arrhythmias and different PVC localizations including information of structural heart diseases due to the small sample size in this study.Conflicts of Interest: Viktor M. Tikhonenko - CEO (Director General) of the Institute of Cardiology Technics (INCART), Saint-Petersburg, Russia.

Preliminary application of Region 4 Stork project used in newborn screening by tandem mass spectrometry

Objective To investigate the feasibility of Region 4 Stork (R4S) project used for newborn screening by tandem mass spectrometry in China. Methods This retrospective study was performed among 362 822 neonates screened by tandem mass spectrometry from May 2015 to April 2016 in Zhejiang newborn screening center. Infants were grouped by screening result category: 83 true positive cases, 360 554 true negative cases and 2 185 false positive cases. Raw data was uploaded into R4S website to perform postanalytical interpretive tools, then results were analyzed with interpretation rules. The comparisons of normal population percentiles were done at five selected percentiles between Zhejiang newborn screening center and R4S project with min-max normalization. Results Compared with cutoff system by using R4S project with interpretation rules, the positive predictive value increased from 3.7% to 8.3%, the specificity increased from 99.40% to 99.75%, and the false positive rate declined from 0.6% to 0.2%. The two cases of true positive hyperprolinemia were reported negative, and one case of β-ketothiolase deficiency was misdiagnosis. Totally 311 638 cases in true negative group were resolved by postanalytical interpretive tools, and the remaining 48 916 cases were excluded with interpretation rules. False positive cases were reduced to 897 cases. Results of percentiles comparison showed that levels of some markers were significantly different between zhejiang newborn screening center and R4S project. Conclusions R4S project effectively improved the newborn screening performance, whereas leaded to a small number of misdiagnosis and missed diagnosis. Besides, many true negative cases should be excluded with interpretation rules. Optimization should be achieved based on local normal population.(Chin J Lab Med, 2018, 41: 300-304) Key words: Metabolism, inborn errors; Tandem mass spectrometry; Neonatal screening; False positive reactions

Pain in the Neck: Are We Potentially at Risk?

Clinical symptoms of the patient with Eagle syndrome (ES) are usually very subtle and often confusing even for the most seasoned clinicians. This confusion may lead to a vast number of misdiagnoses. When an elongated styloid process becomes symptomatic, usually the symptoms are varied for each individual, due to the complex nature of the head and neck region. It is essential that a diagnosis of ES be included when evaluating many head and neck conditions. Some cases might require further extensive examination, since ES presents with various heterogeneous symptoms, making it extremely challenging to diagnose. Recently, a case was reported of a sudden death due to ES, a mechanical irritation of the carotid sinus initiated by an elongated styloid process that led to an acute cardiovascular failure. These types of incidences are rare, but very concerning. An elongated styloid process, found frequently in panoramic radiographs, may be a significant and coincidental finding that could possibly be related to many systemic conditions. Therefore, due to calcification of the styloid process, medical attention including a workup would be warranted. A digital panoramic radiograph, readily available in many dental offices, is sufficient to confirm a diagnosis of ES. In rare cases, surgical intervention may become necessary. A cone beam computed tomography (CBCT), which reconstructs a three-dimensional image, can accurately measure the length of the elongated styloid process and assess the severity of the condition. Clinicians, who examine and provide care for the patient with pain in the head and neck region, must become aware of this entity when suspected symptoms are present. J Med Cases. 2017;8(8):237-240 doi: https://doi.org/10.14740/jmc2848w

Misdiagnosis of Spontaneous Intracranial Hypotension as a Risk Factor for Subdural Hematoma.

This study aimed to evaluate the association between misdiagnosis of spontaneous intracranial hypotension (SIH) and subdural hematoma development. Although SIH is more prevalent than expected and causes potentially life-threatening complications including subdural hematoma (SDH), the association between misdiagnosis of SIH and SDH development is not yet evaluated. Retrospective observational study was conducted between January 1, 2005, and December 31, 2014. Adult patients with spontaneous intracranial hypotension (age≥18years) were enrolled. Of the 128 patients with SIH, 111 (86.7%) were in no SDH group and 17 (13.3%) were in SDH group. Their clinical presentation did not show significant different between the two groups, except age, the days from symptom onset to correct diagnosis, and the number of misdiagnoses. Age (odds ratio [OR], 1.15; 95% confidence interval [CI], 1.07-1.23) and the number of times SIH was misdiagnosed (OR, 1.82; 95% CI, 1.03-3.21) were independent risk factors for the development of SDH in SIH patients by multivariate logistic analysis. The clinical outcomes, including length of hospital stay and revisit rate, were similar in the two groups. The number of times SIH was misdiagnosed was associated with the later development of SDH perhaps because of delay in correct diagnosis of SIH. Clinicians would prevent the later complication of SDH in SIH patients by increasing the awareness and a high index of suspicion of SIH.

Is There a Role of Weight-Bearing Tests to Diagnose Meniscal Tears?

Introduction: Non weight-bearing tests are routinely performed to diagnose meniscal tears, recently it has been suggested that tests performed in weight-bearing can produce higher diagnostic values as they effectively imitate the mechanism of injury to the meniscus by increasing axial load. We prospectively evaluated two non-weight bearing meniscal tests (McMurrays and Joint Line Tenderness), with two weight-bearing tests (Thessalys and Eges). The accuracy, sensitivity and specificity values of these tests were then calculated by correlating with arthroscopy findings. Methods: The four clinical tests were performed on 89 subjects pre-operatively. A positive or negative result was recorded following each clinical test and later compared against the arthroscopy findings post operatively. Results: The weight-bearing tests were overall shown to have a better diagnostic value than non-weight bearing tests. For the medial meniscus, joint line tenderness was the most sensitive test; Eges the most specific, Thessalys had the highest PPV and NPV and was the most accurate. For the lateral meniscus, joint line tenderness was the most sensitive; Mcmurrays the most specific, Thessalys had the highest PPV and NPV and was the most accurate. All four tests were more accurate for medial meniscus compared to lateral. Other pathologies found within the knee were shown to have negative effect on the clinical efficacy of the tests and the highest number of misdiagnoses for meniscal tears occurred with the JLT. Conclusion: This study suggests that the overall clinical ability of the weight-bearing tests to determine the true presence or absence of a Meniscus tear is higher than non-weight-bearing tests.

Functional Imaging for Determination of Nephroblastoma: An Obligatory Diagnostic Program

In Europe, 1.7 % of children with predicted nephroblastoma undergo neoadjuvant chemotherapy without being correctly diagnosed. It is necessary to reduce the number of misdiagnoses. In a girl who was referred to our institute with the diagnosis of nephroblastoma of the right kidney, DMSA scan revealed a hypertrophic compensation of the contralateral nephropathy in the lower part. Functional imaging studies of the kidney should be performed in patients in whom the type of pathology of a suspect mass in the kidney region is unclear, including a careful scrutiny of the MRI scan.

Clinical aspects of Parkinson disease

Parkinson disease is a slowly progressive neurodegenerative disorder with a varied clinical picture and a variable rate of progression. Recently, there have been some studies conducted to assess the diagnostic accuracy and other clinical aspects of the disease. In the absence of a biomarker the clinical diagnosis is imprecise. This leads to a significant number of misdiagnoses, especially in early disease. Assessment of the clinical features suggests that an accuracy of 90% may be the highest that can be expected using current diagnostic criteria. In addition to bradykinesia, which is a core symptom, different types of tremors occur. Whereas the rest tremor is characteristic, action tremor, re-emergent tremor and orthostatic tremor may occur in Parkinson disease. Symptomatic treatments are quite effective in early disease but clinical course is complicated by the appearance of motor fluctuations and dyskinesias in more advanced disease. Non-motor complications, such as cognitive, psychiatric and autonomic problems, become bothersome and disabling in some patients.

Interstitial cystitis in men

Objectives. To determine the personal characteristics, the mode of presentation, the duration of the delay in diagnosis, the number of misdiagnoses, the means to achieve diagnosis, and previous treatment provided for a group of men with interstitial cystitis (IC). Methods. A chart review of 29 men diagnosed with IC at our facility from 1988 to 1996 was performed. Basic demographic data, historical information, laboratory findings, and endoscopic and biopsy results were tabulated. Results. IC in this series of men was diagnosed at a mean age of 67.3 years. There was approximately a 4-year diagnostic lag between presentation and diagnosis. The most common prior erroneous diagnoses were prostatitis in 48% and benign prostatic hypertrophy (BPH) in 38% of the men. Ulcers were encountered cystoscopically in about 70% and biopsy specimens uniformly showed nonspecific chronic cystitis at the time of diagnosis. Conclusions. IC should be considered in the differential diagnosis of voiding disorders accompanied by irritative symptoms and pelvic pain in older men. The diagnosis should be especially considered in men who are refractory to the usual treatments for BPH and prostatitis. Cystoscopy and bladder distention under anesthesia provided the most useful objective information in our hands. Biopsy is useful to rule out inflammatory cancer but adds little to the diagnosis of IC.

Update in preimplantation genetic diagnosis. Age, genetics, and infertility.

PGD has been successfully used for several years. Over 40 babies have been born worldwide by use of these techniques. Unfortunately, a number of misdiagnoses have been made, a distressing consequence of a new frontier. Significant advances have been made to improve the efficiency and accuracy of PCR and FISH. The widespread use of this technology awaits further documentation of safety and accuracy. Other issues must also be addressed. First, the cost-effectiveness of the techniques relative to the traditional alternatives must be evaluated. A number of ethical issues regarding embryo screening must be addressed including what diseases are serious enough to warrant the procedure. Another concern is the use of this technology for nongenetic disorders such as gender selection. Finally, the experimental nature of these procedures must continually be discussed with patients, and long-term follow-up studies must be undertaken. Development of more accurate and less expensive assays coupled with improved IVF success rates may make PGD a more widely used clinical tool. The future awaits these developments.

Illness behavior in rheumatoid arthritis

To explore prediagnostic illness behavior in rheumatoid arthritis (RA). In this descriptive study, interview and medical records data from 50 female patients were analyzed using quantitative and qualitative techniques. Findings revealed a high incidence of symptom normalization, self-treatment, symptom comparison, and prolonged time to diagnosis with multiple misdiagnoses and physicians consulted. Most subjects reported invalidation of initial symptoms, multifaceted emotional distress, and relief upon accurate diagnosis. Significant associations were found between (a) illness-related symptom attributions and fewer physicians consulted (P < 0.05) and less invalidation (P < 0.05); (b) life stress events and fewer physicians consulted (P < 0.05) and shorter time to diagnosis (P < 0.05); (c) remissions and time to diagnosis (P < 0.05), number of physicians consulted (P < 0.001), and number of misdiagnoses (P < 0.001). Illness behavior in RA is prolonged, convoluted, and accompanied by personal and social stress. Invalidation of reported symptoms and relief upon definitive diagnosis are prominent features of the process.