Searching for a prodrome for rheumatoid arthritis in the primary care record: A case-control study in the clinical practice research datalink |
| |
Authors: | Sara Muller Samantha Hider Annabelle Machin Rebecca Stack Richard A Hayward Karim Raza Christian Mallen |
| |
Institution: | 1. Research Institute for Primary Care & Health Sciences, David Weatherall Building, Keele University, Keele, Staffordshire ST5 5BG, UK;2. Haywood Academic Rheumatology Centre, Haywood Hospital, Stoke-on-Trent, UK;3. College of Business Law & Social Sciences, Nottingham Trent University, Nottingham, UK;4. Institute of Inflammation and Ageing, Arthritis Research UK Rheumatoid Arthritis Pathogenesis Centre of Excellence and MRC Arthritis Research UK Centre for Musculoskeletal Ageing Research, University of Birmingham, Birmingham, UK;5. Department of Rheumatology, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK |
| |
Abstract: | BackgroundRheumatoid arthritis (RA) has articular and non-articular manifestations. Early, intensive treatment has substantial benefit for both. This requires patients be identified as soon as symptoms develop.ObjectivesTo determine whether selected signs and symptoms can be identified in the primary care records of patients prior to a formal diagnosis of RA being made and, if so, how early they can be identified.MethodsA case-control study was constructed within the UK Clinical Practice Research Datalink (CPRD). 3577 individuals with ‘definite’ RA, were matched to 14,287 individuals without inflammatory arthritis. An index date was established (i.e., date general practitioner (GP) first appeared to suspect RA). Rates of consultation and consultations for suspected early RA symptoms were compared in cases and controls in the two years prior to the index date using conditional logistic regression, adjusted for number of consultations.ResultsThe mean (standard deviation) age of participants was 58.8 (14.5) years and 66.8% were female. Rates of any consultation were significantly higher in RA cases than in controls for at least two years prior to the index date. Cases were more likely to have a pre-diagnosis coded consultation for joint, and particularly hand symptoms (aOR 11.44 (9.60, 13.63)), morning stiffness (8.10 (3.54, 18.5)), carpal tunnel syndrome (4.57 (3.54, 5.88)) and other non-articular features.ConclusionsIn patients who develop RA, GP consultation rates are higher for at least two years prior to the first recorded suspicion of RA. This study highlights symptoms that should raise a GP's index of suspicion for RA. |
| |
Keywords: | Rheumatoid arthritis Diagnosis Primary care |
本文献已被 ScienceDirect 等数据库收录! |
|