Arthritis & Rheumatism, Volume 63,
November 2011 Abstract Supplement
Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Chicago, Illinois November 4-9, 2011.
Benefits of the Implementation of Specialized Clinics in Rheumatoid Arthritis for Rule Out False Positives of Disease and Osteoarthritis As a Frequent Cause of Misdiagnosis.
Valle-Onate2, Rafael, Arbelaez1, Ana Milena, Cubides1, Maria F., Guzman-Saltis2, Claudia, Amador1, Luisa Fernanda, Gonzalez-Malaver2, Felipe, Santos-Moreno1, Pedro
The lack of expertise in the diagnosis of rheumatoid arthritis (RA) has led to misdiagnosis of patients with the disease, which has had clinical, pharmaco-economic and social consequences. The objective of this study was to describe the clinical and demographic characteristics of a cohort of patients with misdiagnosis of RA, emphasizing in Osteoarthritis (OA) as one of the most frequent causes of erroneous diagnosis of RA and the beneficial role of a specialized in RA clinic for rule out false positive patients.
In a specialized center in RA for the past 6 months were followed 2204 patients with presumptive diagnosis of this disease (patients were seen and remitted to the center by general practitioners, internists, physiatrists and other related specialties).
Included in the study patients were evaluated by a rheumatologist; it was made a complete medical history; it was measured rheumatoid factor and anti-citrullinated antibodies, and other laboratories depending on each case.Also was performed x-rays of hands, and in some cases of persistent doubt about the diagnosis was requested comparative MRI of hands.
Afterwards, patients with false positive diagnosis of RA were analyzed for obtain information about those diseases which can misdiagnosis RA.
Statistical analysis was performed using STATA10. It was applied Shapiro-Wilk test to assess the kind of distribution of data. Afterwards, it was used Wilcoxon's test (for these not normally distributed data) obtaining medians for each variable.
The analysis of continuous variables was performed descriptively by presenting summary statistics and P values. For categorical data, absolute and relative frequency was calculated. The difference of medians showed a statistically significant in each of the variables analyzed, given by a P value < 0.05 for all of them.
Of all the 2204 patients evaluated, in 1186 patients (53.8%) had confirmed the diagnosis of RA. It was found that 1018 patients (46.2%) were misdiagnosed with RA. Of these "false positives" diagnoses were found the following entities: 729 osteoarthritis patients (71.6%), systemic lupus erythematosus 72 patients (7%), Sjogren syndrome 30 patients (2.9%), spondyloarthropathies 23 patients (2.3%) and other diagnoses 16.2% of the population remaining.
As was seen, OA still with 729 patients (71.6%) the disease most often led to misdiagnosis. 230 patients (37%) were men, and 499 patients (63%) women. The average age was 54.3 years. Many of these patients had diagnosis of RA and were receiving disease-modifying drugs (DMARDs) continuously on average during the last 4.5 years.
This study shows that OA is the main distraction in the misdiagnosis of AR with serious clinical, social and pharmaco-economic implications associated.
Also demonstrate the urgent need for the implementation of specialized clinics in RA avoiding internists and the development of effective education strategies for primary care physicians and related specialties to conduct a proper diagnosis of RA.
To cite this abstract, please use the following information:
Valle-Onate, Rafael, Arbelaez, Ana Milena, Cubides, Maria F., Guzman-Saltis, Claudia, Amador, Luisa Fernanda, Gonzalez-Malaver, Felipe, et al; Benefits of the Implementation of Specialized Clinics in Rheumatoid Arthritis for Rule Out False Positives of Disease and Osteoarthritis As a Frequent Cause of Misdiagnosis. [abstract]. Arthritis Rheum 2011;63 Suppl 10 :321