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Realising early recognition of arthritis in times of increased telemedicine: the value of patient-reported swollen joints
  1. Cleo Rogier1,
  2. Bastiaan T van Dijk2,
  3. Elisabeth Brouwer3,
  4. Pascal H P de Jong1,
  5. Annette H M van der Helm-van Mil1,2
  1. 1Department of Rheumatology, Erasmus Medical Center, Rotterdam, Zuid-Holland, The Netherlands
  2. 2Department of Rheumatology, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands
  3. 3Department of Rheumatology and Clinical Immunology, UMCG, Groningen, The Netherlands
  1. Correspondence to Dr Cleo Rogier, Rheumatology, Erasmus Medical Center, Rotterdam 3015GD, The Netherlands; c.rogier{at}

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Early diagnosis and management of patients with inflammatory arthritis (IA) are critical to improve long-term patient outcomes. Assessment of joint swelling at joint examination is the reference of IA identification; early access clinics are constructed to promote this early recognition. Due to the COVID-19 pandemic, the face-to-face capacity of such services is severely reduced.1 This raises the concern of a major step backward after the important progress that has been made in the past 15 years.1 Telemedicine has recently become rapidly implemented. Although probably a valuable alternative in the management of established rheumatoid arthritis (RA), there is also the fear that this might cause delay in the speed of diagnosis.2 A symptom that evidently raises suspicion for IA during remote evaluation is the presence of patient-reported swelling. This symptom is also included in triage tools.3 4

The accuracy of patient-reported swelling in comparison with joint examination has been extensively evaluated in established RA. Heterogeneous results are reported; correlation coefficients were higher when patient scored their swelling on mannequins (ρ: 0.31–0.67) than when determined with questions.5 Hypothetically, the accuracy of patient-reported joint swelling for first recognition of IA is different than for flare detection in patients with established RA. To promote evidence-based care in the era of telemedicine, we determined the accuracy of patient-reported joint swelling for actual presence of IA in persons suspected of IA …

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