Study Links Multiple Doctor Visits to Delayed Rheumatic Diagnosis

A cross-sectional observational study published in Advances in Rheumatology has identified significant delays in the diagnostic and treatment pathways for patients with immune-mediated rheumatic diseases (IMRDs) in Brazil. The research, conducted at two reference centers for rheumatic disease treatment in Rio de Janeiro, analyzed the medical journeys of 1,327 patients from the onset of their symptoms to the initiation of specific treatment. The findings highlight that the time between symptom onset and treatment initiation is a key factor influencing prognosis, with the median time to obtain a definitive diagnosis being 12 months. This study provides a detailed look at the barriers faced by patients within the Brazilian public health system, emphasizing the complex nature of recognizing these conditions in primary care settings.

The study aimed to evaluate the medical journey of individuals with IMRDs, a group of rheumatological conditions that have a substantial impact on morbidity and mortality globally. Due to the diversified nature of IMRD symptoms, timely recognition in primary care can be challenging. The researchers utilized a cross-sectional observational design based on the analysis of questionnaire responses. Quantitative variables were compared using the Mann-Whitney or Kruskal-Wallis test, while categorical and nominal variables were analyzed using McNemar’s test. This methodological approach allowed the team to assess the duration between symptom onset and treatment initiation, a period that significantly influences the overall prognosis for patients with these complex conditions.

The results revealed that the median time until the first rheumatologist consultation after symptom onset was 7 months, with a range of 0.5 to 216 months. The median time to obtain a definitive diagnosis of IMRD was 12 months, also ranging from 0.5 to 216 months. These delays varied significantly depending on the specific condition. For individuals with systemic lupus erythematosus (SLE), the diagnostic period was shorter, with a median of 8 months. In contrast, patients with psoriatic arthritis (PsA) experienced a much longer wait, with a median time to diagnosis of 33 months, ranging from 2 to 195 months.

A significant finding from the study was the impact of the number of medical consultations on the diagnostic timeline. It was shown that consulting two or more non-rheumatologist doctors before seeing a rheumatologist significantly delayed the IMRD diagnosis, with a p-value of less than 0.001.

Beyond the clinical delays, the study examined the impact of the diagnosis on the patients’ emotional well-being and occupational capacity. The diagnosis of IMRD had a negative impact on the emotional well-being of 85.9% of the participants, corresponding to 1,139 individuals. Furthermore, 68.1% of the participants, or 903 individuals, indicated that their work was affected in a negative way.

The emotional journey of the patients also showed distinct phases. Throughout the diagnostic journey, negative feelings predominated in the period in which the diagnosis was not defined. However, there was a notable shift after the confirmation of the diagnosis, with an increase in positive emotions such as happiness, comfort, and well-being.

The study concludes that there is a need for multifaceted interventions to improve the management of these complex conditions. The challenges faced in the medical journey of patients with IMRDs, from delays in diagnosis to barriers in accessing treatment, require a comprehensive approach.

Subject of Research: Diagnostic delays and patient experience in immune-mediated rheumatic diseases in Brazil

Article Title: Understanding barriers: patient experience with immune-mediated rheumatic diseases in Brazilian public health

Article References: Tupinambá, H., Pereira, L. R., Gottgtroy, C., Rios Gomes Bica, B. E., Moss, I. B., Sadigurschi, G., Alves Portela dos Santos, E., Reis Xavier, J., Cristina Caetano Kuschnir, M., Cardoso Doria da Gama, V., da Matta de Castro, T., & Sousa Maia, M. D. L. D. (2026). Understanding barriers: patient experience with immune-mediated rheumatic diseases in Brazilian public health. Advances in Rheumatology. https://doi.org/10.1186/s42358-026-00563-x

Image Credits: AI Generated

DOI: 10.1186/s42358-026-00563-x

Keywords: rheumatology, diagnostic delay, Brazil, public health, patient experience, immune-mediated diseases, systemic lupus erythematosus, psoriatic arthritis, cross-sectional study, healthcare barriers, Understanding, barriers