Daniel G Fernández-Ávila1, María Ximena Rojas2, Sergio A Mora3, Paola Varela Rojas4, Lucía Vanegas-García5, Ana María Sapag-Durán6, Andrés Alberto Hormaza7, Andres Ricardo Fernández8, Antonio Cachafeiro-Vilar9, Belia Lucía Meléndez10, Carlo V Caballero-Uribe11, Carlos Enrique Toro-Gutiérrez12, Daniel Rubén Palleiro-Rivero13, Diego Alejandro Jaimes-Fernández14, Dina Maria Arrieta15, Fausto Álvarez16, Gineth Paola Pinto-Patarroyo17, Guillermo Andrés Quiceno18, Guillermo Pons-Estel19, Jose A Gómez Puerta20, Jossiell Then Báez21, Juan Manuel Bello-Gualtero22, Juan Martín Gutiérrez23, Juan Sebastian Segura24, Leandro Gabriel Ferreyra25, Lilith Stange26, Lina Maria Saldarriaga27, Manuel Francisco Ugarte-Gil28, Mario H Cardiel29, Mario Javier Moreno30, Maritza Quintero31, Marlon B Porras32, Nelly Colman33, Nilmo Noel Chávez34, Oscar Orlando Ruiz4, Paul Méndez-Patarroyo35, Ricardo Machado-Xavier36, Tomás Caicedo37, Vanessa Ocampo38, Wilson Armando Bautista-Molano39, Yimy F Medina40, Yurilis Josefina Fuentes-Silva41, Enrique R Soriano25. 1. PhD. Program in Clinical Epidemiology, Department of Clinical Epidemiology and Biostatistic, School of Medicine, Pontificia Universidad Javeriana-Hospital Universitario San Ignacio, Carrera 7 No. 40 - 62, Bogotá, Colombia. daniel.fernandez@javeriana.edu.co. 2. Department of Clinical Epidemiology and Biostatistic, Medicine Faculty, Pontificia Universidad Javeriana, Bogotá, Colombia. 3. Hospital Universitario de La Samaritana, Universidad de La Sabana, Bogotá, Colombia. 4. Organización Keralty - EPS Sánitas, Bogotá, Colombia. 5. Hospital Universitario San Vicente Fundación - Grupo de Reumatología, Universidad de Antioquia, Medellín, Colombia. 6. Hospital Universitario Japonés, Santa Cruz, Bolivia. 7. Fundación Valle de Lili, Cali, Colombia. 8. Asociación Colombiana de Reumatología - INMUNAR S.A.S, Medellín, Colombia. 9. Pacífica Salud - Hospital Punta Pacífica, Panama City, Panamá. 10. Hospital de la Policía Nacional N1 Quito, Quito, Ecuador. 11. Universidad del Norte, Barranquilla, Colombia. 12. Centro de Referencia en Osteoporosis y Reumatología, Cali, Colombia. 13. Instituto Nacional de Reumatología del Uruguay, Universidad de la República, Montevideo, Uruguay. 14. Clinicos IPS, Universidad de La Sabana, Bogotá, Colombia. 15. Hospital México, San José, Costa Rica. 16. Privacy Practice, Tunja, Colombia. 17. Arthritis and Osteoporosis Center of Northern Virginia, Manassas, USA. 18. Southwestern Medical Center, University of Texas, Dallas, USA. 19. Centro Regional de Enfermedades Autoinmunes y Reumáticas CREAR, Hospital Provincial de Rosario, Rosario, Argentina. 20. Hospital Clínic, Barcelona, Spain. 21. Hospital Metropolitano de Santiago (HOMS), Santiago, Dominican Republic. 22. Hospital Militar Central, Universidad Militar Nueva Granada, Bogotá, Colombia. 23. Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogotá, Colombia. 24. Clínica Mediláser, Neiva, Colombia. 25. Hospital Italiano de Buenos Aires, Buenos Aires, Argentina. 26. Centro de Artritis Reumatoide - Clínica Ciudad del Mar, Viña del Mar, Chile. 27. Hospital Universitario San Jorge, Universidad Tecnológica de Pereira, Pereira, Colombia. 28. Hospital Nacional Guillermo Almenara Irigoyen, EsSalud - Universidad Científica del Sur, Lima, Peru. 29. Centro de Investigación Clínica de Morelia, Morelia, Mexico. 30. Hospital General Luis Vernaza, Universidad de Especialidades Espíritu Santo, Guayaquil, Ecuador. 31. Instituto Autónomo Hospital Universitario de Los Andes, Universidad de Los Andes, Mérida, Venezuela. 32. Organización Keralty - EPS Sánitas, Bucaramanga, Colombia. 33. Hospital de Clínicas, Universidad Nacional de Asunción, Asunción, Paraguay. 34. Instituto Guatemalteco de Seguridad Social, Guatemala City, Guatemala. 35. Fundación Santafé de Bogotá, Universidad de Los Andes, Bogotá, Colombia. 36. Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil. 37. Hospital Universitario Departamental De Nariño, Pasto, Colombia. 38. Centre for Prognosis Studies in the Rheumatic Disease, The University of Toronto, Toronto, Canada. 39. Hospital Universitario Fundación Santa Fe de Bogotá, Universidad El Bosque, Bogotá, Colombia. 40. Universidad Nacional de Colombia, Bogotá, Colombia. 41. Centro Clínico Universitario de Oriente, Universidad de Oriente, Ciudad Bolívar, Venezuela.
Abstract
BACKGROUND: Rheumatic diseases are a reason for frequent consultation with primary care doctors. Unfortunately, there is a high percentage of misdiagnosis. OBJECTIVE: To design an algorithm to be used by primary care physicians to improve the diagnostic approach of the patient with joint pain, and thus improve the diagnostic capacity in four rheumatic diseases. METHODS: Based on the information obtained from a literature review, we identified the main symptoms, signs, and paraclinical tests related to the diagnosis of rheumatoid arthritis, spondyloarthritis with peripheral involvement, systemic lupus erythematosus with joint involvement, and osteoarthritis. We conducted 3 consultations with a group of expert rheumatologists, using the Delphi technique, to design a diagnostic algorithm that has as a starting point "joint pain" as a common symptom for the four diseases. RESULTS: Thirty-nine rheumatologists from 18 countries of Ibero-America participated in the Delphi exercise. In the first consultation, we presented 94 items to the experts (35 symptoms, 31 signs, and 28 paraclinical tests) candidates to be part of the algorithm; 74 items (25 symptoms, 27 signs, and 22 paraclinical tests) were chosen. In the second consultation, the decision nodes of the algorithm were chosen, and in the third, its final structure was defined. The Delphi exercise lasted 8 months; 100% of the experts participated in the three consultations. CONCLUSION: We present an algorithm designed through an international consensus of experts, in which Delphi methodology was used, to support primary care physicians in the clinical approach to patients with joint pain. Key Points • We developed an algorithm with the participation of rheumatologists from 18 countries of Ibero-America, which gives a global vision of the clinical context of the patient with joint pain. • We integrated four rheumatic diseases into one tool with one common symptom: joint pain. It is a novel tool, as it is the first algorithm that will support the primary care physician in the consideration of four different rheumatic diseases. • It will improve the correct diagnosis and reduce the number of paraclinical tests requested by primary care physicians, in the management of patients with joint pain. This point was verified in a recently published study in the journal Rheumatology International (reference number 31).
BACKGROUND:Rheumatic diseases are a reason for frequent consultation with primary care doctors. Unfortunately, there is a high percentage of misdiagnosis. OBJECTIVE: To design an algorithm to be used by primary care physicians to improve the diagnostic approach of the patient with joint pain, and thus improve the diagnostic capacity in four rheumatic diseases. METHODS: Based on the information obtained from a literature review, we identified the main symptoms, signs, and paraclinical tests related to the diagnosis of rheumatoid arthritis, spondyloarthritis with peripheral involvement, systemic lupus erythematosus with joint involvement, and osteoarthritis. We conducted 3 consultations with a group of expert rheumatologists, using the Delphi technique, to design a diagnostic algorithm that has as a starting point "joint pain" as a common symptom for the four diseases. RESULTS: Thirty-nine rheumatologists from 18 countries of Ibero-America participated in the Delphi exercise. In the first consultation, we presented 94 items to the experts (35 symptoms, 31 signs, and 28 paraclinical tests) candidates to be part of the algorithm; 74 items (25 symptoms, 27 signs, and 22 paraclinical tests) were chosen. In the second consultation, the decision nodes of the algorithm were chosen, and in the third, its final structure was defined. The Delphi exercise lasted 8 months; 100% of the experts participated in the three consultations. CONCLUSION: We present an algorithm designed through an international consensus of experts, in which Delphi methodology was used, to support primary care physicians in the clinical approach to patients with joint pain. Key Points • We developed an algorithm with the participation of rheumatologists from 18 countries of Ibero-America, which gives a global vision of the clinical context of the patient with joint pain. • We integrated four rheumatic diseases into one tool with one common symptom: joint pain. It is a novel tool, as it is the first algorithm that will support the primary care physician in the consideration of four different rheumatic diseases. • It will improve the correct diagnosis and reduce the number of paraclinical tests requested by primary care physicians, in the management of patients with joint pain. This point was verified in a recently published study in the journal Rheumatology International (reference number 31).
Authors: R F Ambrose; L G Kendall; G S Alarcón; S Brown; J M Lipstate; D D Wirtschafter; J R Jackson; S Glass; K Rossi; C Z Margolis Journal: Arthritis Care Res Date: 1990-06