Artikel
Daily clinical care of patients with musculoskeletal complaints – how helpful is a triage system for early recognition of inflammatory rheumatic diseases?
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Autoren
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Xenofon Baraliakos
- Rheumazentrum Ruhrgebiet Herne und Ruhr Universität Bochum, Herne
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Imke Redeker
- Deutsches Rheuma-Forschungszentrum, Berlin
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Maria Zacharopoulou
- Rheumazentrum Ruhrgebiet Herne und Ruhr Universität Bochum, Herne
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Styliani Tsiami
- Rheumazentrum Ruhrgebiet Herne und Ruhr Universität Bochum, Herne
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Konstantia Tsiaousi
- Rheumazentrum Ruhrgebiet Herne und Ruhr Universität Bochum, Herne
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Doris Morzeck
- Rheumazentrum Ruhrgebiet Herne und Ruhr Universität Bochum, Herne
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Jürgen Braun
- Rheumazentrum Ruhrgebiet Herne und Ruhr Universität Bochum, Herne
| Veröffentlicht: | 9. September 2020 |
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Gliederung
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Introduction: Early diagnosis and treatment are important for the management of inflammatory rheumatic diseases (RMD). However, the availability of rheumatologists is limited and selection strategies lack sensitivity and/or specificity. We evaluated a triage strategy with the possibility to see patients within 4 and check the probability of a RMD.
Methods: Physician’s and patient’s information who called our tertiary rheumatology department´s outpatient clinic for a date in the triage system were included. Time to first appointment assessed by a nurse (Step 1), short evaluation by a rheumatologist in the triage (Step 2) and patient’s complaints and diagnoses (Step 3) were documented.
Results: Overall, 982 patients presented. 62 patients (6.3%) were considered urgent (appointment within 3 days), while 240 (24.4%) were appointed within 4 weeks at Step 2. Of the former 46 (19.2%), and of the latter 151 patients (62.9%) were diagnosed with RMD at Step 3.
At Step 3 126 patients were diagnosed with RA (37.7%), 71 with axSpA/PsA (21.3%), 95 with connective tissue disease/vasculitis (28.4%) and 20 with gout (6.0%). The diagnosis suspected in Step 2 was confirmed in Step 3 in 77.9% of cases, while in 217 was not confirmed. Of them, 34 (15.7%) had unclear findings at Step 2 but a RMD was found at Step 3, while 148 (68.2%) had a suspected RMD at Step 2 but this was not confirmed at Step 3.
The most frequent complaint at referral was pain in small joints (858 patients, 87.4%), in large joints (780, 79.4%) and back pain (682, 69.5%). Fever/night sweats/unclear weight loss was reported by 50 patients (5.1%), while 210 (24.5%) presented with findings suspicious of RMD and 43 (4.8%) because of a threat of organ damage such as elevated creatinine. 167 patients (17.0%) had received glucocorticoids prior to referral, 87 (52.1%) of which did not receive the diagnosis of RMD at Step 3, while 737 patients (75.1%) were receiving NSAIDs prior to referral.
Conclusion: In this prospective evaluation, clinical differentiation could be performed timely due to a successfully structured triage system. The initially suspected diagnosis was finally confirmed in ≥75% of cases, while ≥1/3 of patients had a RMD.
Disclosures: None declared
