Session Information
Date: Sunday, November 13, 2016
Title: Rheumatoid Arthritis – Clinical Aspects - Poster I: Clinical Characteristics/Presentation/Prognosis
Session Type: ACR Poster Session A
Session Time: 9:00AM-11:00AM
ACR ABSTRACT 2016 Early detection of inflammatory arthritis: the role of musculoskeletal symptoms, infections and rheumatoid arthritis-related comorbidities in primary care Background/Purpose: Rheumatoid arthritis is characterized by clinically apparent inflammatory arthritis (IA). A preclinical phase has been recognized in which symptoms arise and ambulatory care utilization increases. However, information on location and timing of symptoms before IA diagnosis is still largely lacking. The present study was undertaken to identify pathogenetic clues to the development of IA and to assist early identification of future IA patients with a focus on musculoskeletal symptoms, infections and chronic comorbidities.
Methods:
We conducted a nested case-control study using data from electronic medical records of general practitioners, participating in NIVEL Primary Care Database, to evaluate timing and numbers of visits for 192 symptoms and diseases up to nine years before diagnosis of IA. To this end we used the International Classification of Primary Care (ICPC-1) coding system. 2772 patients who received a new diagnosis of IA between 2012 and 2014 were matched (ratio 1:2) with controls on age, gender, general practice and retrospective duration of follow-up. The frequency of primary care visits between the IA patients and controls were compared using logistic regression in different time periods before diagnosis.Results:
The consultation rate for musculoskeletal symptoms was increased in IA patients in the last 1.5 years before diagnosis with odds ratios (ORs) of 1.8 (confidence interval; CI: 1.6-2.1, p-value<0.05), 1.4 (CI 1.2-1.6, p<0,05) and 1.3 (CI 1.1-1.5, p<0.05), respectively, at 6, 12 and 18 months before diagnosis. For infections, the consultation rate was significantly higher 6 and 18 months prior to diagnosis (OR=1.2; both CI: 1.1-1.4, p-value<0.05). Finally, for IA-related disease and other chronic diseases a significant difference was observed only 3 months before diagnosis with ORs of 1.2 (CI 1.02-1.3, p<0.05) and 1.3 (CI 1.1-1.5, p<0.05) respectively. All ORs are corrected for age and gender. Important contributors to the above mentioned significance levels were presence of shoulder complaints (16.1% in the IA-patients versus 9.6% in the controls; chi2 73.9, p<0.001), hand/finger complaints syndrome (12.2% versus 5.6%; chi2 112.5, p<0.001), carpal tunnel syndrome (5% versus 2.5%; chi2 37.1, p<0.001) and foot/toe complaints (15.2% versus 9.2%; chi2 67.0, p<0.001).Conclusion:
We found significantly increased consultation rates in general practice for musculoskeletal symptoms and infectious diseases prior to the diagnosis of IA. This diverging trend started 4-6 years before diagnosis, but becomes statistically significant around 1.5 years preceding diagnosis. Possibly, these symptoms can be used to develop methods for earlier detection of IA in general practice.
Disclosure: M. van Beers-Tas, None; M. Nielen, None; J. C. Korevaar, None; D. van Schaardenburg, None.
To cite this abstract in AMA style:
van Beers-Tas M, Nielen M, Korevaar JC, van Schaardenburg D. Early Detection of Inflammatory Arthritis: The Role of Musculoskeletal Symptoms, Infections and Rheumatoid Arthritis-Related Comorbidities in Primary Care [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/early-detection-of-inflammatory-arthritis-the-role-of-musculoskeletal-symptoms-infections-and-rheumatoid-arthritis-related-comorbidities-in-primary-care/. Accessed .« Back to 2016 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/early-detection-of-inflammatory-arthritis-the-role-of-musculoskeletal-symptoms-infections-and-rheumatoid-arthritis-related-comorbidities-in-primary-care/