Design of an algorithm for the diagnostic approach of patients with joint pain

• Published in: Clinical rheumatology Vol. 40; no. 4; pp. 1581 - 1591
• Main Authors: Fernández-Ávila, Daniel G., Rojas, María Ximena, Mora, Sergio A., Varela Rojas, Paola, Vanegas-García, Lucía, Sapag-Durán, Ana María, Hormaza, Andrés Alberto, Fernández, Andres Ricardo, Cachafeiro-Vilar, Antonio, Meléndez, Belia Lucía, Caballero-Uribe, Carlo V., Toro-Gutiérrez, Carlos Enrique, Palleiro-Rivero, Daniel Rubén, Jaimes-Fernández, Diego Alejandro, Arrieta, Dina Maria, Álvarez, Fausto, Pinto-Patarroyo, Gineth Paola, Quiceno, Guillermo Andrés, Pons-Estel, Guillermo, Gómez Puerta, Jose A., Báez, Jossiell Then, Bello-Gualtero, Juan Manuel, Gutiérrez, Juan Martín, Segura, Juan Sebastian, Ferreyra, Leandro Gabriel, Stange, Lilith, Saldarriaga, Lina Maria, Ugarte-Gil, Manuel Francisco, Cardiel, Mario H., Moreno, Mario Javier, Quintero, Maritza, Porras, Marlon B., Colman, Nelly, Chávez, Nilmo Noel, Ruiz, Oscar Orlando, Méndez-Patarroyo, Paul, Machado-Xavier, Ricardo, Caicedo, Tomás, Ocampo, Vanessa, Bautista-Molano, Wilson Armando, Medina, Yimy F., Fuentes-Silva, Yurilis Josefina, Soriano, Enrique R.
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01-04-2021; Springer Nature B.V
• Subjects: Algorithms; Arthralgia - diagnosis; Arthritis; Diagnosis; Humans; Inflammatory diseases; Literature reviews; Medicine; Medicine & Public Health; Original Article; Osteoarthritis; Pain; Patients; Primary care; Rheumatic diseases; Rheumatic Diseases - complications; Rheumatic Diseases - diagnosis; Rheumatoid arthritis; Rheumatologists; Rheumatology; Systemic lupus erythematosus; Rheumatoid; Algorithms; Physicians; Lupus erythematosus; Arthritis; Systemic; Osteoarthritis; Primary care; Spondyloarthritis
• DOI: 10.1007/s10067-020-05323-w
• EISSN: 1434-9949
• ISSN: 0770-3198

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).