Session Type: Abstract Submissions (ACR)
Background/Purpose: RA and SLE are more severe and at least twice as prevalent in the First Nations population of Canada compared to the Caucasian population. Difficulties in accessing rheumatology care have been previously documented. A collaboration between a Blackfoot community (n= 3,700) and rheumatologists from a nearby urban centre was initiated to enable better consultative services for the Nation’s members, and allow for established rheumatology patients to receive care in their home community. Parallel to this initiative, we established an arthritis screening program, with the primary goal being to identify new cases of inflammatory arthritis (IA) early in the disease course.
Methods: A weekly community-based screening program started in June 2011. Consenting participants undergo a musculoskeletal (MSK) history and examination by a rheumatologist and complete a Health Assessment Questionnaire (HAQ). Serologic testing (rheumatoid factor (RF), antinuclear antibody (ANA), extractable nuclear antigens (ENA), anti-cyclic citrullinated peptide (anti-CCP)) is offered and further investigations initiated as appropriate to confirm a diagnosis. Management is provided in conjunction with primary care providers. We provide here a descriptive summary of the program’s outcomes after 1 year.
Results: 144 individuals have been reviewed (74% female, mean age 52.4 years). Half the cohort have a family history of RA (52%) or SLE (18%). All individuals have at least 1 MSK symptom, and 68% report fatigue. The most common sites of joint pain are the hands (81%), knees (75%), lumbar spine (64%), and shoulders (55%). A primary care provider had been consulted by 72% of the cohort prior to the screening program, with 15% having seen a rheumatologist and 15% an orthopedic surgeon in the past. The median HAQ score was 0.88, the median pain score (0-10 VAS) 5, and the median patient global score 5 (0-10 VAS). Seventeen new cases of rheumatic disease have been diagnosed (10 RA, 3 PsA, 1 JIA, 1 Sjogren Syndrome with arthralgias, 2 crystal arthropathies) and 4 individuals remain under observation. Fourteen patients with established rheumatic diseases (6 RA, 1 PsA, 1 spondyloarthritis, 5 SLE, 1 JIA) have re-engaged in active rheumatology care. OA and/or degenerative disk disease was present in 58% of the participants screened, 42% had soft tissue syndromes, 2% had fibromyalgia and 6% had a neurologic condition causing pain. RF and anti-CCP antibodies were rarely positive; anti-CCP was present in low or medium titres in 4 individuals with either soft tissue syndromes or OA. ANA was positive in 52% of the group, with 28% having titres >1:320. In those with positive ANA, only 5 had a history of SLE, IA or RA.
Conclusion: The screening program has been successful in detecting new cases of early IA and returning established rheumatology patients to active care in this First Nations community. There is a significant burden of OA in the community, and many residents are ANA positive in the absence of apparent connective tissue disorders. These findings highlight the need for a multidisciplinary team of primary care providers, allied health professionals, and specialists to maximize MSK care in the community. Limitations at this early phase include participation bias.
C. Low Horn,
D. P. Mosher,
H. S. El-Gabalawy,
M. J. Fritzler,
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/detection-of-inflammatory-arthritis-and-musculoskeletal-conditions-in-a-first-nations-community-results-of-an-onsite-screening-program/