The ability of rheumatologists blinded to prior workup to diagnose rheumatoid arthritis only by clinical assessment: a cross-sectional study

Rheumatology
Boris EhrensteinWolfgang Hartung

Abstract

We aimed to study the ability of board-certified rheumatologists, blinded to all prior diagnostic test results, to establish the presence/absence of an inflammatory rheumatic disease (IRD) or RA among polyarthralgia or arthritis patients, solely relying on clinical assessment. We performed a prospective, examiner-blinded, cross-sectional study documenting the diagnostic work in four sequential steps (medical history, physical examination, musculoskeletal ultrasonography and laboratory tests) of board-certified rheumatologists in a convenience cohort of 100 patients referred for inpatient diagnostic workup to a tertiary care rheumatology centre. The ability to correctly identify patients with or without an IRD (diagnostic accuracy) increased from 27% after the clinical assessment to 53% after the ultrasonography and to 70% after taking laboratory test results into account. The corresponding values for correctly identifying patients with or without RA were 19, 42 and 60%, respectively. Therefore the diagnostic accuracy of solely clinical assessment for determining the diagnosis of IRD or RA compared with the diagnosis established by a consecutive thorough in-patient workup was only 27 and 19% in our cohort, respectively. Pretreat...Continue Reading

References

Mar 17, 2004·Annals of the Rheumatic Diseases·R J WakefieldP Emery
Feb 10, 2006·The New England Journal of Medicine·Sandeep Jauhar
May 22, 2010·Arthritis Research & Therapy·Lotte A van de StadtDirkjan van Schaardenburg
Oct 12, 2013·Journal of Investigative Medicine : the Official Publication of the American Federation for Clinical Research·Maria-Magdalena TămaşSimona Rednic
Oct 2, 2014·Arthritis Research & Therapy·Hamed RezaeiRonald F van Vollenhoven
Nov 3, 2016·Rheumatology International·Philip Rask Lage-HansenLene Terslev

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