TY - JOUR
T1 - Use of Rheumatologic Testing in Patients Who Eventually Receive a Diagnosis of Rheumatoid Arthritis
AU - Singh, Dilpreet K.
AU - Badwal, Jasdeep
AU - Vankina, Ritika
AU - Gokaraju, Santhi
AU - Friderici, Jennifer
AU - Halista, Scott
AU - Lagu, Tara
N1 - Funding Information:
From the Arthritis Treatment Center; Department of Internal Medicine, University of Massachusetts/Baystate Health, Springfield, Massachusetts; Texas Health Presby, Dallas, TX; and CIgna HealthCare, Bloomfield, Connecticut. Correspondence to Dr Dilpreet Singh, Arthritis Treatment Center, 3377 Main St, Springfield, MA 01107. E-mail: dilpreetsinghmd@gmail.com. To purchase a single copy of this article, visit sma.org/smj-home. To purchase larger reprint quantities, please contact Reprintsolutions@wolterskluwer.com. T.L. has received compensation from the National Heart, Lung, and Blood Institute/National Institutes of Health; the Yale Center for Outcomes Research and Evaluation and the Institute for Healthcare Improvement, both under contract to the Centers for Medicare & Medicaid Services. The remaining authors did not report any financial relationships or conflicts of interest. Accepted July 10, 2019. Copyright © 2019 by The Southern Medical Association 0038-4348/0–2000/112-535 DOI: 10.14423/SMJ.0000000000001026
Publisher Copyright:
© Lippincott Williams & Wilkins.
PY - 2019/10/1
Y1 - 2019/10/1
N2 - Objectives Anti-cyclic citrullinated peptide antibody (ACPA) has excellent specificity and prognostic value in patients with early rheumatoid arthritis (RA). The American College of Rheumatology included ACPA in their 2010 classification criteria for RA, but we hypothesize that primary care physicians (PCPs) underuse ACPA, even when clinical suspicion for RA is high. We aimed to describe their use of diagnostic testing in patients who were referred to a rheumatologist and eventually diagnosed as having RA. Methods In this retrospective cohort study, a systematic abstraction tool was used to review the medical records of patients seen between January 1, 2010 and June 15, 2014 in two rheumatology clinics: one private practice and one community health center associated with an academic medical center. For purposes of hypothesis generation, we compared the characteristics of patients with and without testing using unpaired t tests or Fisher exact tests. Results We identified 173 patients with RA referred from 141 different PCPs: 82.7% were women with a mean ± standard deviation age of 55.5 ± 18.6 years. ACPA and rheumatoid factor were ordered in 28.9% (95% confidence interval 22.6-36.2) and 41.0% (95% confidence interval 33.9-48.6) of patients, respectively. Imaging was underused. Almost half (45.7%, or 37/81) of the patients with documented symptom duration had a delay of at least 1 year before referral; however, ACPA utilization was not associated with the delay to treatment initiation. Conclusions Most PCPs failed to order diagnostic tests for RA before referring a patient with polyarthritis who eventually received a diagnosis of RA. We also observed delays in diagnosis, with half of the patients waiting >1 year from symptom onset to diagnosis. These findings suggest educational efforts for PCPs should focus on emphasizing earlier diagnostic workups, especially ACPA, in patients suspected to have RA.
AB - Objectives Anti-cyclic citrullinated peptide antibody (ACPA) has excellent specificity and prognostic value in patients with early rheumatoid arthritis (RA). The American College of Rheumatology included ACPA in their 2010 classification criteria for RA, but we hypothesize that primary care physicians (PCPs) underuse ACPA, even when clinical suspicion for RA is high. We aimed to describe their use of diagnostic testing in patients who were referred to a rheumatologist and eventually diagnosed as having RA. Methods In this retrospective cohort study, a systematic abstraction tool was used to review the medical records of patients seen between January 1, 2010 and June 15, 2014 in two rheumatology clinics: one private practice and one community health center associated with an academic medical center. For purposes of hypothesis generation, we compared the characteristics of patients with and without testing using unpaired t tests or Fisher exact tests. Results We identified 173 patients with RA referred from 141 different PCPs: 82.7% were women with a mean ± standard deviation age of 55.5 ± 18.6 years. ACPA and rheumatoid factor were ordered in 28.9% (95% confidence interval 22.6-36.2) and 41.0% (95% confidence interval 33.9-48.6) of patients, respectively. Imaging was underused. Almost half (45.7%, or 37/81) of the patients with documented symptom duration had a delay of at least 1 year before referral; however, ACPA utilization was not associated with the delay to treatment initiation. Conclusions Most PCPs failed to order diagnostic tests for RA before referring a patient with polyarthritis who eventually received a diagnosis of RA. We also observed delays in diagnosis, with half of the patients waiting >1 year from symptom onset to diagnosis. These findings suggest educational efforts for PCPs should focus on emphasizing earlier diagnostic workups, especially ACPA, in patients suspected to have RA.
KW - anti-cyclic citrullinated peptide antibody
KW - diagnostic delay
KW - quality improvement
KW - rheumatoid arthritis
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U2 - 10.14423/SMJ.0000000000001026
DO - 10.14423/SMJ.0000000000001026
M3 - Article
C2 - 31583414
AN - SCOPUS:85072930549
VL - 112
SP - 535
EP - 538
JO - Southern Medical Journal
JF - Southern Medical Journal
SN - 0038-4348
IS - 10
ER -