Sandwell and West Birmingham Hospitals NHS Trust and Centre for Translational Inflammation Research, University of Birmingham, Birmingham, UK.
Arthritis Care Res (Hoboken). 2013 Dec;65(12):1916-26. doi: 10.1002/acr.22097.
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.
如果要尽早发现患者并开始治疗，了解类风湿关节炎（RA）早期阶段的症状特征和模式非常重要。然而，对于最终发展为 RA 的疾病初始阶段的症状特征，我们知之甚少。
系统检索了定性同行评议文献，以确定与 RA 发病相关的最早症状。共搜索了 1736 篇摘要，以确定相关出版物。确定了 26 篇出版物，对其进行了质量评估，并根据主题和扎根理论框架进行了分析。
确定了描述 RA 早期症状的几个相互作用的主题，包括肿胀、疼痛和压痛、僵硬、疲劳和虚弱以及症状的情绪影响。对于每种症状，都描述了不同和不断变化的强度；在某些情况下，强调了 RA 发病时症状的发作模式和症状群。重要的是，本次综述强调了文献中的主要缺陷。没有一项研究最初旨在探索 RA 发病时的症状（通常关于症状发作的讨论是研究主要目的的次要内容）。此外，许多确定的文章样本都是多年前被诊断患有 RA 的人，因此他们对发病时症状的回忆不太可靠。
为了让临床医生全面了解疾病的最早阶段，需要了解发病时的症状性质。目前的工作是一个有用的起点，但这一领域需要进一步进行定性研究，随后对症状群及其相关特征进行定量探索。
