Background The lack of expertise and skills in the diagnosis of in rheumatoid arthritis (RA) in primary level of Colombian medical centers can cause misdiagnosis of rheumatic diseases. Due to this issue in a specialized center in RA we stablished a multidisciplinary model and a strict disease management algorithm to diagnose properly our patients; as a consequence we have achieved the accurate diagnosis of great proportion of patients that were false positives diagnosed initially as RA.
Objectives The aim of this study was to show effectiveness and accuracy of a screening method to avoid false-positive diagnosis of RA in a cohort of patients with supposed diagnosis of RA.
Methods During two years we evaluated patients with presumptive diagnosis of RA. We conducted a cross-sectional study; we included patients who were referred from primary care centers to a RA specialized center in a 24 month period with presumptive diagnosis of (RA). Each patient was evaluated to confirm or rule-out diagnosis of RA as follows: a rheumatologist fulfilled a complete medical record, including joint counts; it was assessed rheumatoid factor and anti-citrullinated antibodies, and other laboratories depending on each case. Also were made x-rays of hands and feet, and in some cases of persistent doubt about the diagnosis was requested comparative MRI of hands or/and feet. Descriptive epidemiology was perfomed.
Results Between 2015 and 2016 6813 patients were evaluated in our specialized center, in 76% of cases RA was confirmed, the remaining 1593 patients (24%) had a wrong diagnosis of RA; of these misdiagnosed patients, (87%) were female, and 205 (13%) male, with an average age of 62±12 years. Between differential diagnosis which were found in this cohort of misdiagnosed patients: osteoarthritis in 849 patients (63.3%), Sjögren syndrome (7%) Systemic lupus erythematosus (6%) the remaining 30% of patients had conditions such as gout, psoriasis, osteoporosis, myalgia, soft tissue diseases among others. The majority of patients with wrong diagnosis took DMARDs (23%), calcium (11%), biologics (10%) acetaminophen (9%), neuropathy medications (7%), acetaminophen plus opioids (5%), osteoporosis medications (5%), opioids (4%), glucosamine (4%), diacerein (3%), the remaining patients took medications such as NSAID, glucosamine, antigout agents, gastritis drugs, among others.
Conclusions The results of this program show that almost 25% patients with presumptive RA diagnosis are misdiagnosed; this is evidence that can be extrapolated to primary care centers in Colombia. The most important cofounding diagnosis was osteoarthritis and many patients were receiving DMARDs for treatment. For this reason there is an urgent need of education strategies for primary care physicians and the implementation of centers of excellence in RA, in order to conduct a proper diagnose and avoid clinical and health economics consequences of misdiagnosis.
Disclosure of Interest None declared