Algorithm for Identification of Undifferentiated Peripheral Inflammatory Arthritis: A Multinational Collaboration Through the 3e Initiative

Hazlewood, Glen; Aletaha, Daniel; Carmona, Loreto; Landewé, Robert; Heijde, Désirée M van der; Bijlsma, J. W. J.; Bykerk, Vivian P.; Canhão, Helena; Catrina, Anca I.; Durez, Patrick; Edwards, Christopher J; Leeb, Burkhard F.; Mjaavatten, Maria D; Martínez-Osuna, P; Montecucco, Carlomaurizio; Østergaard, Mikkel; Serra-Bonett, Natali; Xavier, Ricardo Machado; Zochling, Jane; Machado, Pedro; Thevissen, Kristof; Vercoutere, Ward; Bombardier, Claire

doi:10.3899/jrheum.101076

Cited by 11 publications

(2 citation statements)

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“…The care management of rheumatic diseases prior to referral can provide critical insights into the knowledge and clinical decision‐making of primary care physicians. Laboratory investigations can support early diagnosis and guide referral , but there are concerns over misuse, misinterpretation of results, excessive costs, and negative tests that can delay referrals . The total incidence of rheumatology‐related laboratory testing practices of family physicians are not well understood, as analyses are often confined to results reported on referral letters within rheumatology practices .…”

Section: Discussionmentioning

confidence: 99%

Patterns of Care Among Patients Referred to Rheumatologists in Ontario, Canada

Widdifield

Thorne

et al. 2016

Arthritis Care & Research

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Objective Our aim was to characterize referrals to rheumatologists, the early care management of patients with rheumatic diseases, and timeliness of care and treatment. Methods We conducted a retrospective observational study involving patients with first‐time rheumatology referrals between 2000 and 2013 in the primary care Electronic Medical Record Administrative data Linked Database (EMRALD) in Ontario, Canada. Referrals were characterized in terms of diagnoses, patient demographics, diagnostic tests, treatment initiated by family physicians and rheumatologists, and other specialists seen prior to rheumatology consultation. Timeliness of referrals, rheumatologist consultations, and treatment were determined overall and for each diagnostic category. Results Among 2,430 patients referred to a rheumatologist, 69% were female, with an average age of 53 years. The principal diagnosis associated with the referral included osteoarthritis (32%), systemic inflammatory rheumatic diseases (31%), regional musculoskeletal conditions (16%), chronic pain conditions (14%), osteoporosis (2%), and other/miscellaneous (5%). Family physicians most frequently prescribed nonsteroidal antiinflammatory drugs/cyclooxygenase 2 inhibitors (38%), and their pre‐referral diagnostic testing practice varied considerably. The duration of time from symptom onset to rheumatology consultation varied by diagnoses, with the shortest being for patients with systemic rheumatic diseases; for rheumatoid arthritis (RA), the median time to consultation was 327 days. Most of the delay occurred prior to referral; 36% of RA patients initiated a disease‐modifying antirheumatic drug within 6 months of symptom onset. Conclusion Approximately 1 in 3 referrals to rheumatologists were for a systemic inflammatory rheumatic disease. We observed substantial delays to rheumatology consultations and variations in patterns of care that could be amenable to quality improvement interventions.

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Section: Discussionmentioning

confidence: 99%

Patterns of Care Among Patients Referred to Rheumatologists in Ontario, Canada

Widdifield

Thorne

et al. 2016

Arthritis Care & Research

View full text Add to dashboard Cite

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“…To this end, after the 9 recommendations were formulated, an expert panel met for a round table discussion with the objective of developing an algorithm for the investigation and followup of UPIA. The algorithm drew on the clinical experience of the consensus panel, the 9 international recommendations, and evidence from the literature 11 .…”

Section: -2009: Systematic Reviews and Clinical Algorithmmentioning

confidence: 99%