Rheumatology referrals often lack key details of patients’ inflammatory arthritis
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Key takeaways:
- Details regarding arthralgia duration, morning stiffness or joint examination findings remain uncommon in rheumatology referrals for inflammatory arthritis.
- The median time from referral to diagnosis was nearly 2 months.
Key details expressing arthralgia duration, morning stiffness or joint examination findings are often missing from rheumatology referral letters for inflammatory arthritis, according to data published in Rheumatology Advances in Practice.
“The American College of Rheumatology (ACR) and European Alliance of Associations for Rheumatology (EULAR) recommend that patients with suspected rheumatoid arthritis be assessed by a rheumatologist within 6 weeks of referral,” Brendan Thoms, MBBS, of the University of Vermont Medical Center, and colleagues wrote. “Distinguishing inflammatory from non-inflammatory arthropathy, however, is not always a straightforward process, and the combination of a high burden of musculoskeletal disease within the population and a shortage of rheumatologists has led to long wait times for initial evaluation.”
To characterize the variables that might indicate whether a patient is afflicted with inflammatory arthritis or non-inflammatory disease, Thoms and colleagues analyzed data from adults aged 18 years or older who were referred to the University of Vermont Medical Center with arthralgia between Jan. 1, 2019, and June 30, 2019.
After establishing the cohort, the researchers accessed reviewed variables from patient referral letters, including information on laboratory and imaging results, demographic data, clinical characteristics and referral sources. Variables of interest included duration of joint arthralgia, joint tenderness and swelling, stiffness in the morning lasting longer than 1 hour, the presence of patient-reported cognitive barriers such as brain fog, a family history of autoimmune disorders, and a personal medical history including psoriasis or inflammatory bowel disease.
The analysis included 697 patients, among whom 25.7% were diagnosed with inflammatory arthritis. Variables common in patients with inflammatory arthritis included joint tenderness and swelling, as well as stiffness in the joints lasting longer than 1 hour in the morning. Meanwhile, factors that were considered “negative predictors” included arthralgia duration, fatigue and brain fog, the researchers wrote.
According to Thoms and colleagues, details regarding any of the positive reflectors were uncommon in referral letters. Arthralgia duration details were present in 31% of notes, while morning stiffness was noted in 20.5% of referrals, and joint examination findings were included in 56.7% of letters.
The median time from referral to diagnosis was 55days, the researchers wrote. In addition, 20.7% of patients were seen within 6weeks.
“Patients with [inflammatory arthritis] were seen sooner than patients with non-inflammatory arthropathy, though only a minority were seen within the target of 6 weeks,” Thoms and colleagues wrote. “This data suggests that a few key aspects of the history and exam are of utmost importance to adequately triage patients in rheumatology clinic but are often missing.”
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