Inflammatory arthritis: case review and primary care perspectives

Cottrell, Elizabeth; Welsh, Victoria; Mallen, Christian

doi:10.1007/s10067-011-1919-7

Cited by 9 publications

(7 citation statements)

References 14 publications

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“… 5 Additionally, patients with negative rheumatoid factor are referred less frequently (66% vs 35%) 40 and had a longer period of delay (67 vs 22 days), 41 compared with those with positive rheumatoid factor. The same conclusion was reached by Kumar et al 11 This scenario is more dramatic when considering X-rays, 42 given the absence of radiographic changes in the early stage of the disease.…”

Section: Barriers At Each Levelsupporting

confidence: 57%

Barriers to the Diagnosis of Early Inflammatory Arthritis: A Literature Review

Saraiva¹,

Duarte²

2023

OARRR

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The early identification of patients with inflammatory arthritis and their referral to rheumatologists in order to establish a diagnosis and to start treatment plays a crucial role in patient outcomes. However, it is recognized that a large proportion of patients with inflammatory arthritis are diagnosed very late, losing the opportunity to start treatment in the very early stages of disease, resulting in a worse prognosis. This delay depends on several factors related to the patient, the disease, socio-demographic and health system aspects. Over time, several strategies have been developed and implemented at different levels aiming to overcome such barriers and to reduce the time from the onset of the symptoms until the diagnosis and start of adequate treatment. In this non-systematic comprehensive review, we will describe the main barriers in the identification of patients with inflammatory arthritis at different levels. We will also discuss the different strategies that have been implemented with the objective to overcome the recognized barriers and their impact in the reduction of delays.

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Section: Barriers At Each Levelsupporting

confidence: 57%

Barriers to the Diagnosis of Early Inflammatory Arthritis: A Literature Review

Saraiva¹,

Duarte²

2023

OARRR

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“…Variations in national health-care structures mean that factors contributing to referral delays need to be considered on a country-specific basis. Data on factors associated with GP referral delays of suspected RA in England are limited, but existing studies suggest that referral decisions are strongly influenced by test results (chiefly RF and radiographs), with negative/normal tests making referral less likely or timely [8–10]. These studies are limited by their regional nature [10], small size [8] or focus on a single factor [9].…”

Section: Introductionmentioning

confidence: 99%

Primary care challenges in diagnosing and referring patients with suspected rheumatoid arthritis: a national cross-sectional GP survey

Scott

Mangat

Macgregor

et al. 2018

Rheumatology Advances in Practice

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Objective National guidelines advocate referring patients with persistent synovitis to rheumatology within 3 working days of presentation to primary care. This occurs infrequently. We aimed to identify modifiable barriers to early referral of suspected RA patients among English general practitioners (GPs). Methods We carried out a national cross-sectional survey of 1388 English GPs (RA Questionnaire for GPs [RA-QUEST] study). Questions addressed GPs’ confidence in diagnosing RA, clinical factors influencing RA diagnosis/referral, timeliness of referrals and secondary care access. Data were captured using 10-point visual analog scales, five-point Likert scales, yes/no questions or free text, and were analysed descriptively. Results Small joint swelling and pain were most influential in diagnosing RA (91 and 84% rated the importance of these as 4 or 5 on a five-point Likert scale, respectively); investigations including RF (61% rating 4 or 5) and anti-CCP antibody (72% rating 4 or 5) were less influential. Patient history had the greatest impact on the decision to refer (92% rating this 4 or 5 on a 5-point Likert scale), with acute phase markers (74% rating 4 or 5) and serology (76% rating 4 or 5) less impactful. Despite the importance placed on history and examination, only 26% referred suspected RA immediately without investigations; 95% of GPs organizing further tests opted to test for RF. Conclusion For suspected RA patients to be referred within 3 days of presentation to primary care there needs to be a paradigm shift in GPs’ approaches to making referral decisions, with a focus on clinical history and examination findings, and not the use of investigations such as RF.

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“…A case-review analysis reported a median delay of 161 days, and a median of 5 visits, for specialist referral of RA patients after primary care presentation [ 30 ]. During the early stages of presentation, 82% of RA patients were not considered by their PCP to have an inflammatory pathology.…”

Section: Discussionmentioning

confidence: 99%

A multicentre validation study of a smartphone application to screen hand arthritis

Reed

Rampono²,

Turner³

et al. 2022

BMC Musculoskelet Disord

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Background Arthritis is a common condition, and the prompt and accurate assessment of hand arthritis in primary care is an area of unmet clinical need. We have previously developed and tested a screening tool combining machine-learning algorithms, to help primary care physicians assess patients presenting with arthritis affecting the hands. The aim of this study was to assess the validity of the screening tool among a number of different Rheumatologists. Methods Two hundred and forty-eight consecutive new patients presenting to 7 private Rheumatology practices across Australia were enrolled. Using a smartphone application, each patient had photographs taken of their hands, completed a brief 9-part questionnaire, and had a single examination result (wrist irritability) recorded. The Rheumatologist diagnosis was entered following a 45-minute consultation. Multiple machine learning models were applied to both the photographic and survey/examination results, to generate a screening outcome for the primary diagnoses of osteoarthritis, rheumatoid and psoriatic arthritis. Results The combined algorithms in the application performed well in identifying and discriminating between different forms of hand arthritis. The algorithms were able to predict rheumatoid arthritis with accuracy, precision, recall and specificity of 85.1, 80.0, 88.1 and 82.7% respectively. The corresponding results for psoriatic arthritis were 95.2, 76.9, 90.9 and 95.8%, and for osteoarthritis were 77.4, 78.3, 80.6 and 73.7%. The results were maintained when each contributor was excluded from the analysis. The median time to capture all data across the group was 2 minutes and 59 seconds. Conclusions This multicentre study confirms the results of the pilot study, and indicates that the performance of the screening tool is maintained across a group of different Rheumatologists. The smartphone application can provide a screening result from a combination of machine-learning algorithms applied to hand images and patient symptom responses. This could be used to assist primary care physicians in the assessment of patients presenting with hand arthritis, and has the potential to improve the clinical assessment and management of such patients.

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Inflammatory arthritis: case review and primary care perspectives

Cited by 9 publications

References 14 publications

Barriers to the Diagnosis of Early Inflammatory Arthritis: A Literature Review

Barriers to the Diagnosis of Early Inflammatory Arthritis: A Literature Review

Primary care challenges in diagnosing and referring patients with suspected rheumatoid arthritis: a national cross-sectional GP survey

A multicentre validation study of a smartphone application to screen hand arthritis

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