Approved Research

Development and external validation of a clinical prediction rule for the diagnosis of inflammatory arthritis

Lay summary

It is now well established that early diagnosis is crucial for achieving remission of various types of inflammatory arthritis. For example, patients with inflammatory arthritis, for example rheumatoid arthritis, do better when the diagnosis is made early after symptom onset, and treatment is started right away.  The first three months after symptoms start, has been termed the "window of opportunity", at which time the initiation of treatment, leads to better outcomes for the patient.  Patients diagnosed within this window of opportunity, are more likely to achieve long-term disease remission, develop less joint damage and deformity, and have less functional limitations in the long term.  For the diagnosis of inflammatory arthritis to be made early, patients must be seen by a rheumatologist quickly.  Joint pain is a common reason for referral to a rheumatologist, and in many regions across the world, the number of referrals received for joint pain exceeds what can be assessed in rheumatology clinics in a timely manner.  Therefore, differentiating patients with a high probability of inflammatory arthritis, from those with osteoarthritis or non-inflammatory joint pain, at the point of triage, is of the utmost importance to ensure patients with inflammatory arthritis are seen within an appropriate time frame.  Differentiating these patients based on information received in the referral letter can be difficult.  Referrals inaccurately triaged as non-urgent and thus low risk of inflammatory arthritis can face significant delays in diagnosis and initiation of appropriate treatment.  We aim to develop a simple rule based on data easily available to a primary care provider, to help rheumatologists and other providers accurately triage referrals which should be seen urgently.  This can ultimately lead to improved outcomes in patients with inflammatory arthritis.