Woeful Rheumatology Referrals Save

Early diagnosis of inflammatory arthritis (IA) is rooted in patient (self or MD) referrals. A recent analysis shows only a minority of rheumatology referrals had inflammatory arthritis, with only 21% were seen within the first 6 weeks of symptoms. 

A total of 1023 were patients referred to the rheumatology division at Vermont Medical Center’s (in the first half of 2019) for arthralgia.  Most patients were referred from primary care (85%), followed by orthopedics (5%) and dermatology (2%).

Of 697 patients evaluated by rheumatology (for arthralgia), 26% were diagnosed with inflammatory arthritis, half with osteoarthritis and 21% with fibromyalgia. 

Overall, referent evaluation of arthralgia as inadequate with 20-31% documenting arthralgia duration or AM stiff, documented joint exam in 57% and a median time delay to rheumatology appointment of 9 weeks. Serological testing was however, common, including tests for ANA (48%), RF (38%), anti-CCP (18%), and HLA-B27 (43%).

Predictors of of IA included tenderness and swelling on examination and ≥1 h of morning stiffness. Negative predictors were arthralgia duration, fatigue and brain fog.

This study underscores the overuse of lab testing (in a majority without IA), delays in referral (a problem contributed by both PCP and rheumatology services) and the lack of communication between specialists and healthcare providers regarding high yield rules and testing and preferred patients for referral.

Earlier capture and diagnosis of IA amongst arthralgia patients would most certainly improve patient outcomes..