Background Early stages of rheumatic diseases (0–12 weeks) including rheumatoid arthritis (RA) are still difficult to diagnose. For this reason, incorrect referrals to a rheumatologist result in a high use of resources in outpatient clinics.
Objectives Implementation of a structured screening system for selecting and treating patients (pts) with RA or other rheumatic and musculoskeletal diseases (RMD).
Methods 98 pts visited a screening appointment for early arthritis (EA) between February 2015 and September 2015 in special EA departments. Inclusion criterion was arthritis ≥ one joint for less than one year recorded by phone. Qualified health professional assistants (HPA) conducted the phone call. Upon screening, all pts filled in a tablet based questionnaire to be developed for future online use about their symptoms. Subsequently, 53 pts (group 1) were seen first by an HPA who analysed the questionnaire and performed the joint count. Based on these findings, the HPA made a suspected diagnosis. Afterwards, also a rheumatologist saw these pts and made a suspected diagnosis. In comparison, the rheumatologist directly examined 45 pts without an HPA (group 2). In both groups, typical clinical findings led to a new appointment, or in acute cases, treatment was started immediately. If an RMD was suspected or laboratory parameters were abnormal, pts received a second appointment as well. The documentation of the real-life data was carried out by the Medpath© system based on medical and flexible adaptable paths.
Results Mean duration between phone call and screening was 19.6±12.8 days. Pts had an age of 18–80 years (mean 51.1±15.5 years), and 73 pts (74.5%) were female. Although all pts had reported symptoms of less than one year over the phone, only 70 pts (71.4%) fulfilled this criterion when asked in the questionnaire. In group 1, according to the HPA 22 of 53 (41.5%) pts had an RMD upon screening. The suspected diagnoses of HPA and rheumatologist corresponded in 43 of 53 (81.1%) pts in the screening. In group 2, the rheumatologist suspected 14 of 45 (31.1%) pts having an RMD in the first visit.
59 (60.2%) pts had no RMD. 23 (23.5%) pts had RA that was seropositive in 14 (14.3%) pts. All RA pts were recommended a therapy with conventional disease modifying antirheumatic drugs (cDMARDs) and glucocorticoids (GC), which 21 (21.4%) pts started 17.2±27.6 days after screening. 3 (3%) pts initially had a preclinical seropositive RA, which changed into definite RA in need for treatment with cDMARDs after 191 days in one patient. 3 (3%) pts received inpatient treatment and systemic lupus erythematosus was diagnosed in one case.
Conclusions The structured screening system efficiently selects pts with RMDs and leads to treating RMD at an early stage in times of limited resources.
Acknowledgement Abbvie supports the project within the T2T Initiative Germany.
Disclosure of Interest None declared