Observational study of a patient and doctor directed pre-referral questionnaire for an early arthritis clinic

Abstract

We evaluated a combined physician and patient questionnaire designed for identifying early rheumatoid arthritis (RA) and spondyloarthritis (SpA) in a cohort of 220 patients supposed for admission to an early arthritis clinic (EAC). The documents including personal and basis demographic data, referral diagnosis, questions related to RA and SpA classification criteria, functional limitations and previous diagnostic and therapeutic attempts were fax-transmitted to referring practices and returned before first EAC appointment. 125 referrals before introduction of the questionnaire served as controls. We found that a functional impairment of the hands provided more accurate prediction of RA than reports on morning stiffness or joint swelling. No clinical data proved predictive for SpA. We observed an unintended increase in the prescription of analgesics/NSAID and corticosteroids. In conclusion, questionnaires as designed here may provide substantial information for diagnosis of RA, but also imply the risk of unmeant therapeutic attempts.

Republished: A systematic literature review of strategies promoting early referral and reducing delays in the diagnosis and management of inflammatory arthritis

“…Our search retrieved four forms that have been tested — these have helped standardise and provided important information for triage 59–62. All included elements of history, physical examination and laboratory tests and some asked for an attempt at diagnosis.…”

Development of a Multidimensional Additive Points System for Determining Access to Rheumatology Services

“…20 This information was absent from 64.9% Acute monoarthritis with specific concern for septic arthritis Giant cell arteritis-significant concern for a diagnosis of giant cell arteritis Acute systemic vasculitis-significant concern for acute development of a systematic vasculitis with major organ involvement, eg, acute pulmonary, cardiac, renal, gastrointestinal, or neurological features; cutaneous vasculitis or digital infarcts Acute connective tissue disease-significant concern for acute development of a connective tissue disease with major organ involvement, eg, acute pulmonary, cardiac, renal, hematological, neurological features; cutaneous vasculitis or digital infarcts Significant unexplained constitutional symptoms of either fever >38°C or weight loss >5% in preceding 6 wk, where there is a strong suspicion that it may relate to a connective tissue disease of referrals in a review of referrals to rheumatology services in the United Kingdom. 21 We acknowledge that people stop work for a wide variety of reasons, and whereas this may not be an important distinguishing factor in the determination of early inflammatory arthritis, 22 it is an important domain to gauge the effect of the problem on the individual.…”

Optimising Use of Electronic Health Records to Describe the Presentation of Rheumatoid Arthritis in Primary Care: A Strategy for Developing Code Lists

“…Previous studies looking at the presentation and management of early RA have been situated in secondary care and are therefore prone to substantial referral bias [30],[31],[32]. The existing work suggests that delay in seeking medical attention is a more important factor than delay in recognition and referral to specialist services [33].…”