A scoping review of triage approaches for the referral of patients with suspected inflammatory arthritis, from primary to rheumatology care

Biln, Norma K.; Bansback, Nick; Shojania, Kam; Puil, Lorri; Harrison, Mark

doi:10.1007/s00296-024-05575-8

Rheumatol Int

2024

DOI: 10.1007/s00296-024-05575-8

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A scoping review of triage approaches for the referral of patients with suspected inflammatory arthritis, from primary to rheumatology care

Norma K. Biln,

Nick Bansback,

Kam Shojania

et al.

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2024

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Cited by 3 publications

References 83 publications

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Rheumatology in the digital health era: status quo and quo vadis?

Knitza,

Gupta,

Hügle

2024

Nat Rev Rheumatol

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Rheumatology in the digital health era: status quo and quo vadis?

Knitza,

Gupta,

Hügle

2024

Nat Rev Rheumatol

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Progressive improvement in time to diagnosis in axial spondyloarthritis through an integrated referral and education system

Chan,

Rigler,

Ahmad

et al. 2024

Rheumatology Advances in Practice

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Objectives To assess the delay in the diagnosis of axSpA in a real world cohort over a 16 year period and to evaluate factors associated with this delay. We implemented a service improvement project and evaluated its effectiveness in improving time to diagnosis of axSpA. Methods A cohort of axSpA patients newly diagnosed between January 2008 to December 2023, were studied. Surveys were carried out in 2013, 2017, 2019 and 2023 to assess time to diagnosis which was divided into four periods from onset of inflammatory back pain to year of axSpA diagnosis. The time to diagnosis over the study period was analysed using a statistical process control chart. Results Over the study period, 988 referrals were received where 366 (37%) had axSpA. There was a progressive increase in the number of females with axSpA. The mean (SD) time to diagnosis significantly reduced from 9.8 (1.2) years in 2008 to 1.0 (1.0) year in 2023. The greatest delay was from the onset of back pain to first seeing their GPs (mean 3.2 years). There was a significant improvement in the mean time to diagnosis across the time periods through the service improvement interventions. Conclusion Structural and organisational change in triage, referral and clinic pathways has led to earlier recognition of axSpA. This is further enhanced through an integrated educational programme and awareness campaign for the public, GPs and healthcare professionals including physiotherapists. With continuous quality improvement cycles, we achieved our aim to reduce mean time to diagnosis to1 year.

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Patient-Reported Outcomes of Depression and Fibromyalgia Symptoms Do Not Predict Non-Inflammatory versus Inflammatory Diagnoses at Initial Rheumatology Consultation

Schäfer,

Kovacs,

Nigg

et al. 2024

Healthcare

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Objective: The objective of this study was to assess the potential value of patient-reported outcomes (PROs) of depression, fibromyalgia symptoms, and pain in predicting non-inflammatory vs. inflammatory diagnoses in rheumatology patients. Methods: This retrospective, single-center study evaluated electronic health record (EHR) data from adults who were seen for their first rheumatology consultation and subsequently received a diagnosis of an inflammatory (e.g., rheumatoid arthritis or spondyloarthritis) or non-inflammatory (e.g., osteoarthritis or fibromyalgia) condition. The PROs evaluated included depressive symptoms (Patient Health Questionnaire-2 [PHQ-2]), fibromyalgia symptom severity (FM SS), and pain. Results: A total of 3669 patients were evaluated, including patients with (n = 984; 26.82%) and without (n = 2685; 73.18%) inflammatory rheumatologic disease, of whom 141 (3.8%) had fibromyalgia. The non-inflammatory subgroup reported higher FM SS scores, and the inflammatory subgroup had higher pain and inflammatory markers. Bivariate models based on PHQ-2 and FM SS had a very low specificity (0.3%) for predicting non-inflammatory conditions, resulting in the misclassification of >99% of inflammatory cases. Adding pain, inflammatory markers, and other relevant EHR variables increased specificity but still resulted in a high level of misclassification. Conclusions: The PROs evaluated in this study are not suitable for predicting non-inflammatory vs. inflammatory rheumatologic disease, even when combined with other EHR variables.

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A scoping review of triage approaches for the referral of patients with suspected inflammatory arthritis, from primary to rheumatology care

Cited by 3 publications

References 83 publications

Rheumatology in the digital health era: status quo and quo vadis?

Rheumatology in the digital health era: status quo and quo vadis?

Progressive improvement in time to diagnosis in axial spondyloarthritis through an integrated referral and education system

Patient-Reported Outcomes of Depression and Fibromyalgia Symptoms Do Not Predict Non-Inflammatory versus Inflammatory Diagnoses at Initial Rheumatology Consultation

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