Criteria used by primary care physicians for the diagnosis and referral to a rheumatologist of patients with rheumatoid arthritis

Xibillé-Friedmann, Daniel; Mondragón-Flores, Victor; Rosa, César Horcasitas de la

doi:10.1016/s1699-258x(06)73053-4

Cited by 4 publications

(7 citation statements)

References 12 publications

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“…In general, previous studies have shown poor agreement in the diagnosis of RA between primary care physicians and rheumatologists [1,15,[24][25][26][27][28][29]. Gamez-Nava et al…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies have estimated the lag time to diagnosis in patients with RA, ranging as widely as from 1 month to 10 years [11][12][13][14]. To our knowledge, such studies have been rarely carried out in non-Caucasians populations and scarce data are available in Latin America [15][16][17]. DiVerences in medical care access, patient and physician's awareness of the disease, and patterns of patient's referral may inXuence the lag time between symptom onset and diagnosis of RA among diVerent health systems around the world.…”

Section: Introductionmentioning

confidence: 99%

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Lag time between onset of symptoms and diagnosis in Venezuelan patients with rheumatoid arthritis

et al. 2010

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A retrospective study in a hospital-based sample of Venezuelan patients with rheumatoid arthritis was made to estimate the lag time between onset of symptoms, diagnosis, and initiation of DMARD treatment. Medical records and in-person interview of patients to fill in a questionnaire collecting information on demographics and initiation of symptoms, first consultation with any physician, time of diagnosis, and initiation of first disease-modifying anti-rheumatic drug were reviewed. We performed descriptive statistics and multivariable linear regression analysis. Mean lag time between symptom onset and diagnosis of rheumatoid arthritis was 40.5 months (range 1-424). Mean lag time between onset of symptoms and first consultation with a physician and between first consultation and diagnosis was 16.3 and 23.9 months, respectively. Mean lag time between onset of symptoms and initiation of DMARD treatment was 56.9 months. A definitive diagnosis of rheumatoid arthritis was done by a rheumatologist in 251 patients (92.3%). First consultation with an orthopedist or a primary care physician, first consultation in a public versus a private health center, and diagnosis before 2000 were associated with longer lag time between onset of symptoms and diagnosis. Venezuelan patients with rheumatoid arthritis had a marked delay from disease onset to diagnosis and initiation of first DMARD. First consultation with an orthopedist and consultation in a public versus a private health center were the variables with the strongest effect on lag time to diagnosis and to initiation of first DMARD.

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“…In general, previous studies have shown poor agreement in the diagnosis of RA between primary care physicians and rheumatologists [1,15,[24][25][26][27][28][29]. Gamez-Nava et al…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Lag time between onset of symptoms and diagnosis in Venezuelan patients with rheumatoid arthritis

et al. 2010

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“…GPs play a key role in identifying patients with inflammatory arthritis, as they typically serve as "gatekeepers" for rheumatologists, being the first contact with the health system for about 90% of patients 9 . Several reasons have been reported to justify the delay in referral to rheumatology [20][21][22][23][24][25][26] . The most common reason is the low confidence in identifying inflammatory arthritis, particularly if the presentation is rather atypical or there is no clear evidence of swollen joints.…”

Section: Discussionmentioning

confidence: 99%

“…The most common reason is the low confidence in identifying inflammatory arthritis, particularly if the presentation is rather atypical or there is no clear evidence of swollen joints. Additionally, GPs tend to value laboratory tests more than their clinical view, preferring to wait for blood tests before referring patients or leading to no referral if negative 19,21,25 . The poor agreement observed in our study, particularly regarding clinical referral criteria, reflects such difficulties.…”

Section: Discussionmentioning

confidence: 99%

10-year experience of early arthritis clinic at a tertiary rheumatology center: achievements and challenges

Maduro,

Pinto Saraiva,

Mendes

et al. 2024

ARP Rheumatol

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Objectives: To characterize patients evaluated in our Early Arthritis Clinic (EAC) in the first ten years; to assess diagnostic delay and its underlying causes; and to evaluate the level of agreement between the referring physician and the rheumatologist regarding the presence of referral criteria. Methods: Cross-sectional study including patients attending EAC between 2012 and 2021. Demographic data, provenience, final diagnosis, referral criteria and time related to diagnosis delay were retrieved from clinical files and the Portuguese Registry of Rheumatic Patients (reuma.pt). Characteristics of the patients and the time variables were analysed with descriptive statistical analysis. The agreement between the referring physician and rheumatologist regarding the referral criteria was evaluated using Cohen's Kappa. Results: A total of 440 patients (68.9% females, mean age of 54±16.7 years) were referred, mostly from primary care (71.6%). Inflammatory Rheumatic Disease was diagnosed in 65.7% of the patients, with 58.9% classified as early arthritis. The median time from onset of symptoms to referral for EAC was 76 days (IQR 33.5-144.0); the median time from referral to the first EAC was 34 (IQR 19.0-46.0) days, and the median time from onset of symptoms to first EAC was 114.5 (IQR 66.8-190.3) days (16.3 weeks). Only about 10% were observed by a Rheumatologist before six weeks after symptom onset. The level of agreement between the referring physician and the rheumatologist was slight to fair to clinical criteria and moderate to substantial to laboratory criteria. Conclusions: A significant delay still is observed in patients with early arthritis suspicion, being the time from onset of symptoms to referral is the most relevant. A low agreement between referral and Rheumatologists suggests that non-rheumatologists education/training is needed. Identifying the barriers that prevent the adequate referral of patients is necessary to define strategies to improve it.

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“…Unfortunately, the early referral to a rheumatologist is not what usually happens in most, if not all LA countries [ 25 , 26 ]. This might be due to several reasons: Most people do not realize that “rheumatism” is a vague term that encompasses many diseases with different treatment and prognosis, so they are not aware that the first thing they need to do is to have a diagnosis to explain their MSK condition; Many people do not have easy access to the healthcare system, delaying the medical evaluation; Most patients with MSK pain are referred by the GP to the specialist without a specific referral criteria (most patients with common diseases such as osteoarthritis, fibromyalgia, and mechanical low back pain should not be referred to a rheumatologist but followed by a GP); Many GP do not readily identify the patients with inflammatory conditions delaying the proper referral to the specialist; There are few rheumatologists in the secondary or tertiary healthcare system so it usually takes some time for this specialist’s appointment; Most, if not all, rheumatology outpatients clinics do not have a triage system or a “fast track agenda” for early arthritis patients (early arthritis clinic—EAC) so even those patients need to wait to be seen.…”

Section: Discussionmentioning

confidence: 99%

Rheumatoid arthritis in Latin America: the importance of an early diagnosis

et al. 2015

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The generalization of the early rheumatoid arthritis (ERA) concept and the existence of a window of therapeutic opportunity—a time span in which the institution of a proper therapeutic method for the disease would determine clinical improvement—have set the notion that early diagnosis and treatment may modify the course of the disease. Although in several regions of the world, especially in North America and Europe, since the year 2000, a significant reduction in diagnostic delay was observed in cohorts of patients with rheumatoid arthritis (RA), probably reflecting a stronger awareness of the importance of early diagnosis, this is not a reality in Latin America (LA). LA is a region of great economic inequality, with disparities in access to the public healthcare system and limited access to private medicine, being widely difficult to obtain a specialized medical evaluation in both scenarios. This paper aims to briefly review the main difficulties in the management of ERA in LA, based on the review of the literature, on the evaluation of a survey conducted among 214 rheumatologists of LA, members of Pan-American League of Associations for Rheumatology (PANLAR) and the experience of the authors. The paper also aims to propose solutions to the difficulties in managing ERA in LA.

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Criteria used by primary care physicians for the diagnosis and referral to a rheumatologist of patients with rheumatoid arthritis

Cited by 4 publications

References 12 publications

Lag time between onset of symptoms and diagnosis in Venezuelan patients with rheumatoid arthritis

Lag time between onset of symptoms and diagnosis in Venezuelan patients with rheumatoid arthritis

10-year experience of early arthritis clinic at a tertiary rheumatology center: achievements and challenges

Rheumatoid arthritis in Latin America: the importance of an early diagnosis

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