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Referral & diagnosis of common rheumatic diseases by primary care physicians

  [ 23 votes ]   [ Discuss This Article ]
By Gamez-Nava JI, Gonzalez-Lopez L, Davis P, Suarez-Almazor ME • www.ProHealth.com • November 5, 1998


OBJECTIVE: To describe primary care patterns of referral and
diagnoses of patients with rheumatic diseases referred to
rheumatologists.
METHODS: The medical records of all
consecutive patients referred in 1994 by >300 primary care
physicians to two rheumatologists at an academic centre were
reviewed. The referring physician diagnosis was compared with
the rheumatologist's diagnosis. Sensitivity, specificity and
predictive values of primary care diagnoses were estimated
using the rheumatologist diagnosis as the 'gold standard'.
SETTING: University-based rheumatology out-patient clinic.
RESULTS: Over half of the patients referred had a
rheumatologist diagnosis of soft-tissue rheumatism or a spinal
pain syndrome. Three hundred and forty-seven patients (49%)
had a primary care diagnosis of a defined rheumatic disease.
Of these, 142 (41%) of the primary care diagnoses were
subsequently modified by the rheumatologist. The highest
agreement between primary care physician and rheumatologist
was observed for crystal-induced arthritis (kappa = 0.86), and
the lowest agreement for polymyalgia rheumatica (kappa = 0.39)
and systemic lupus (kappa = 0.46). Sensitivity was lowest for
a primary care diagnosis of fibromyalgia (48%) and highest for
ankylosing spondylitis (94%). Positive predictive values were
generally low, in particular for systemic lupus erythematosus
(33%) and polymyalgia rheumatica (30%).
CONCLUSION: Most
patients referred to an academic rheumatology centre had
soft-tissue rheumatism or other pain syndromes. In general,
diagnostic agreement between rheumatologists and primary care
physicians was low. Increased emphasis on musculoskeletal
disorders should be encouraged in medical education to
increase the efficiency of rheumatology referrals.




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