Article
Optimizing referral to rheumatology – a new strategy to prevent referral of patients with low likelihood of an inflammatory rheumatic disease
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Authors
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Marvin-Hendrik Röchter
- Klinikum Bielefeld Rosenhöhe, Universitätsklinik für Innere Medizin und Rheumatologie, Bielefeld
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Sophie Schmiegel
- Universität Bielefeld, Fakultät für Wirtschaftswissenschaften, Lehrstuhl für Data Science, Bielefeld
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Hannah Marchi
- Universität Bielefeld, Fakultät für Wirtschaftswissenschaften, Lehrstuhl für Data Science, Bielefeld
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Christiane Fuchs
- Universität Bielefeld, Fakultät für Wirtschaftswissenschaften, Lehrstuhl für Data Science, Bielefeld
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Martin Rudwaleit
- Klinikum Bielefeld Rosenhöhe, Universitätsklinik für Innere Medizin und Rheumatologie, Bielefeld
| Published: | September 18, 2024 |
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Outline
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Introduction: Fibromyalgia syndrome (FMS) is a major driver for rheumatological consultations, delaying the diagnosis and treatment of patients with inflammatory rheumatic diseases (IRD).
The objective of this study was to explore whether the combined application of the Fibromyalgia Rapid Screening Tool (FiRST) and C-reactive protein (CRP) value has potential to identify patients with chronic musculoskeletal pain but a low likelihood of an IRD in primary care.
Methods: In this explorative, prospective single-centre study we investigated the hypothesis of a low likelihood of an IRD in patients with chronic pain and the combination of CRP≤5 mg/l and FiRST≥5 among outpatients and inpatients treated in the rheumatology department between 01/2019 and 01/2022.
The FiRST questionnaire was administered in blinded manner and regardless of established or new IRD diagnosis, disease activity, and treatment.
Results: 1,100 patients with complete datasets were analysed; 69.3% were female, mean age was 54.8 (SD 15.7) years. An IRD was diagnosed in 566 patients (51.5%), FMS in 341 (31.0%), osteoarthritis (OA) in 325 (29.5%) and other diagnoses in 204 patients (18.5%). 94/566 IRD patients (16.6%) had the combination of CRP≤5 mg/l and FiRST≥5, suggesting a low likelihood of an IRD. Among these, 22 patients received a new diagnosis of IRD, of whom 4 patients were treated with prednisolone (potentially affecting the CRP-value) and the diagnosis IRD was dismissed in further 4 patients after meticulous review of available patient information (Figure 1 [Fig. 1]).
Conclusion: The new referral strategy reveals potential to identify in primary care patients with musculoskeletal pain but a low likelihood of IRD. Given an increasing shortage of rheumatologists, such a referral strategy may contribute to timely referrals of patients with an IRD.
Disclosures: This project was funded by the Anschubsfonds Medizinische Forschung (AMF) of Bielefeld University.
