ABSTRACT
Background: The preselection of patients with suspicion of an infammatory rheumatic disease is not easy for general practitioners and orthopedists. In countries with a limited number of practicing rheumatologists waiting lists are often long, since a full rheumatologic examination often needs a long consultation time. Objectives: To test the performance of an early triage strategy for early identif-cation of patients with infammatory rheumatic diseases. Methods: Prior to the SARS-CoV 2 pandemic, physicians caring for patients contacting a tertiary rheumatologic cente were frst contacted by a health-care professional (HPR) who offered an appointment the timing of which was based on the symptoms reported (Step 1). Patients were then seen by a rheumatolo-gist who, within a 10-minute consultation (Step 2), shortly examined the patient to determine the urgency of a planned full work up. The main outcome of the study was the comparison between the initial assessment and the fnal expert diagnosis (Step 3). Results: Within 9 months, physicians caring for 1.180 patients contacted the hospital, 972 of whom kept their appointment (82.4%). Most patients were transferred by GPs (73.1%) and orthopedists (22.1%). The mean time between Step 1 and Step 2 was 10.4 days, while 6.2% of patients were seen within 4 days, 24.4% within 7 days and 69.3% within 12 weeks. Only 36 patients (3.7%) of patients had an already established rheumatic disease. Complaints lasting between 0-4 weeks were reported by 69 (7.1%), of > 4-12 weeks by 100 (10.3%), and of > 12 weeks by 973 (82.6%) patients. Almost 90% of patients reported a pain intensity >4/10 (NRS) for < 2 weeks. An elevated CRP was found in 207 patients (24.5%). Prior treatment with glucocorticoids was reported in 163 (16.8%) and with NSAIDs in 730 (75.1% of) patients. The confirmed diagnosis at Step 3 was rheumatoid arthritis in 127 (13.1%), spondyloarthritis including pso-riatic arthritis in 72 (7.4%), systemic diseases including connective tissue diseases in 112 (11.5%), vasculitides in 41 (4.2%), and crystal arthropathy in 38 (3.9%) patients, while 38 (3.9%) had an infection, a malignancy or a differential diagnosis such as Raynaud's phenomenon or sicca syndrome. Degenerative joint diseases (n=254;26.1%) and non-inflammatory soft tissue syndromes such as fibromyalgia (n=369;38%) accounted for more than half of the patients. Conclusion: This study describes the performance of a standardized triage system hereby confrming the need for an early identifcation and preselection of patients with rheumatic musculoskeletal symptoms, including involvement of HPRs in the initial phase of contact. Based on the results, three patients with musculoskeletal complaints had to be examined in order to identify one patient with an infammatory rheumatic disease.
ABSTRACT
Background: Rheumatology departments across the UK have adapted to the COVID-19 pandemic, implementing novel methods of working via remote consultations. Objectives: We wanted to explore the rates of telemedicine consultations for patients with Rheumatoid Arthritis (RA), Giant cell arteritis (GCA), Osteoarthritis (OA), and Crystal arthritis (CA). We also wanted to check how effective the tele-medicine consultations had been in terms of avoiding the need for a face-to-face appointment. Methods: No telemedicine consultations took place before the COVID-19 pandemic in patients diagnosed with GCA, RA, CA and OA. We assessed the number of telemedicine consultations (telephone or videocall) using data from the departmental database covering September 2020 to December 2021. We analysed the rates of face-to-face versus telemedicine appointments for both new referrals and follow-up consultations. The statistical analysis was conducted using chi-square test. Results: There were 20,648 patients assessed in our department from September 2020 to December 2021. In total 1786 face-to-face and 2079 telemedi-cine consultations were conducted for GCA (18%), RA (66%), OA (13%) and CA (3%). The highest percentage of telemedicine consultations versus face-to-face for new referrals were observed for OA (30% Vs 70%) followed by RA (14% Vs 86%), CA (12% Vs 88%) and GCA (2% Vs 98%) (Table 1). Combining all these conditions, 68% of clinicians felt the telemedicine appointment avoided a face-to-face appointment. However, 33% of clinicians seeing new patients with RA did not feel the telemedicine appointment avoided a face-to-face appointment. In contrast, follow-up appointments were mainly conducted by telemedicine when compared with face-to-face;RA (65% Vs 35%), GCA (53%Vs 47%), OA (51% Vs 49%) and CA (61% Vs 39%). For the follow-ups, an overall majority of 90% of telemedicine consultations avoided the need for a face-to-face appointment, particularly observed for patients with CA and GCA (98% and 93% respectively). We noted that patients with RA were more likely than GCA to have a telemedicine follow-up (p value<0.00001). Conclusion: Telemedicine appointments for new referrals and follow-up patients with Rheumatological diagnoses has been a new development because of COVID-19 pandemic. Our analysis shows that most of our new RA, GCA, OA, and CA referrals are still being seen face-to-face but most follow-up appointments are telemedicine consultations. In most cases, clinicians felt that telemed-icine consultations avoided the need for a face-to-face appointment.
ABSTRACT
Background: The COVID-19 pandemic has had profound effects on the Rheumatology department;we wanted to see if consequently referrals for Rheumatoid arthritis (RA), Crystal Arthritis (CA), Osteoarthritis (OA) and Giant cell arteritis (GCA) were affected. A greater understanding of the impact may enable adequate number of clinics and resources to be made available where needed. Objectives: To evaluate the impact of COVID-19 pandemic on volume of new referrals to the Rheumatology department for RA, CA, OA and GCA. Methods: A retrospective analysis of data was conducted from the period of January 2016 to December 2021. The Rheumatology department database was closely analysed and information about new referrals for GCA, RA, OA and CA were evaluated. Statistical analysis was conducted using t-test to compare the mean value pre and during the COVID19 outbreak (2020). Results: From 2016 to 2021 a total number of 9998 new patients were referred to the Rheumatology department. There were 2768 new referrals for GCA (15%), RA (34%), OA (40%) and CA (11%) made during this period. In 2020, there was a signifcant decrease in OA, RA and CA referrals (p value 0.000004, 0.00017, 0.0042 respectively) but an insignifcant decrease in GCA referrals (p value 0.243). Conclusion: During COVID19 pandemic in 2020 there was a signifcant reduction in the number of new referrals for RA, OA, and CA in contrast to GCA where the referrals have been constant. This may be due to the detrimental consequences of untreated GCA with regards to risk of sight loss. However, with less RA referrals, this may result in a delayed diagnosis with an impact on the disease course.