PMID- 34553506
OWN - NLM
STAT- MEDLINE
DCOM- 20221220
LR  - 20230203
IS  - 2151-4658 (Electronic)
IS  - 2151-464X (Linking)
VI  - 74
IP  - 12
DP  - 2022 Dec
TI  - Diagnostic Performance and Clinical Utility of Referral Rules to Identify Primary 
      Care Patients at Risk of an Inflammatory Rheumatic Disease.
PG  - 2100-2107
LID - 10.1002/acr.24789 [doi]
AB  - OBJECTIVE: To determine the diagnostic performance and clinical utility of the 
      Rotterdam Early Arthritis Cohort (REACH) and the Clinical Arthritis Rule (CARE) 
      referral rules in an independent population of unselected patients from primary 
      care. METHODS: This study consisted of adults who were suspected of the need for 
      referral to a rheumatologist by their general practitioner. Diagnostic accuracy 
      measures and a net benefit approach were used to compare both rules to usual care 
      for recognizing inflammatory arthritis and inflammatory rheumatic diseases 
      (IRDs). Using the least absolute shrinkage and selection operator method and 
      cross-validation we created an optimal prediction rule for IRD. RESULTS: This 
      study consisted of 250 patients, of whom 42 (17%) were diagnosed with 
      inflammatory arthritis and 55 (22%) with an IRD 3 months after referral. 
      Considering inflammatory arthritis, the area under the receiver operating 
      characteristic curve (AUC) was 0.72 (95% confidence interval [95% CI] 0.64-0.80) 
      for REACH and 0.82 (95% CI 0.75-0.88) for CARE. Considering IRD, the AUC was 0.66 
      (95% CI 0.58-0.74) for REACH and 0.76 (95% CI 0.69-0.83) for CARE. CARE was of 
      highest clinical value when compared to usual care. The composite referral rule 
      for IRD of 10 parameters included sex, age, joint features, acute onset of 
      symptoms, physical limitations, and duration of symptoms (AUC 0.82 [95% CI 
      0.75-0.88]). CONCLUSION: Both validated rules have a net benefit in recognizing 
      inflammatory arthritis as well as IRD compared to usual care, but CARE shows 
      superiority over REACH. Although the composite referral rule indicates a greater 
      diagnostic performance, external validation is needed.
CI  - (c) 2021 American College of Rheumatology.
FAU - van Delft, Elke Theodora Antonia Maria
AU  - van Delft ETAM
AD  - Maasstad Hospital, Rotterdam, The Netherlands.
FAU - Barreto, Deirisa Lopes
AU  - Barreto DL
AD  - Maasstad Hospital, Rotterdam, The Netherlands.
FAU - van der Helm-van Mil, Annette Helena Maria
AU  - van der Helm-van Mil AHM
AD  - Leiden University Medical Center, Leiden, and Erasmus Medical Center, Rotterdam, 
      The Netherlands.
FAU - Alves, Celina
AU  - Alves C
AD  - Ziekenhuisgroep Twente, Almelo, The Netherlands.
FAU - Hazes, Johanna Maria Wilhelmina
AU  - Hazes JMW
AD  - Erasmus Medical Center, Rotterdam, The Netherlands.
FAU - Kuijper, Tjallingius Martijn
AU  - Kuijper TM
AD  - Maasstad Hospital, Rotterdam, The Netherlands.
FAU - Weel-Koenders, Angelique Elisabeth Adriana Maria
AU  - Weel-Koenders AEAM
AD  - Maasstad Hospital and Erasmus University, Rotterdam, The Netherlands.
LA  - eng
SI  - ClinicalTrials.gov/NCT03454438
PT  - Journal Article
DEP - 20220731
PL  - United States
TA  - Arthritis Care Res (Hoboken)
JT  - Arthritis care & research
JID - 101518086
SB  - IM
MH  - Adult
MH  - Humans
MH  - Referral and Consultation
MH  - ROC Curve
MH  - *Arthritis
MH  - Primary Health Care
MH  - *Rheumatic Diseases/diagnosis
EDAT- 2021/09/24 06:00
MHDA- 2022/12/21 06:00
CRDT- 2021/09/23 07:19
PHST- 2021/08/24 00:00 [revised]
PHST- 2021/06/25 00:00 [received]
PHST- 2021/09/15 00:00 [accepted]
PHST- 2021/09/24 06:00 [pubmed]
PHST- 2022/12/21 06:00 [medline]
PHST- 2021/09/23 07:19 [entrez]
AID - 10.1002/acr.24789 [doi]
PST - ppublish
SO  - Arthritis Care Res (Hoboken). 2022 Dec;74(12):2100-2107. doi: 10.1002/acr.24789. 
      Epub 2022 Jul 31.