{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T22:45:51Z","timestamp":1791499551318,"version":"4.3.4"},"reference-count":40,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2023,8,3]],"date-time":"2023-08-03T00:00:00Z","timestamp":1691020800000},"content-version":"vor","delay-in-days":214,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,8,26]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>Early diagnosis and treatment of inflammatory arthritis (IA) is essential to optimize disease control. We aimed to identify variables that distinguish IA from non-inflammatory arthropathy by performing a cross-sectional study of rheumatology referral letters and visit records. Further work describes time to assessment and documentation of variables within referral letters.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We reviewed rheumatology referral letters and new patient visits over a 6-month period. The diagnosis of IA was based on the clinical judgement of the assessing rheumatologist. IA diagnoses included RA, SpAs, unspecified IA, PMR, crystalline arthropathies and remitting seronegative symmetrical synovitis with pitting oedema. Univariate analysis was performed for each variable. Multivariable logistic regression was performed on statistically significant variables.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Of 697 patients referred for arthralgia, 25.7% were diagnosed with IA. Variables predictive of IA included tenderness and swelling on examination and \u22651\u2009h of morning stiffness. Increasing arthralgia duration, fatigue and brain fog were negative predictors. The median time from referral to IA diagnosis was 55\u2009days and 20.7% of these patients were seen within 6\u2009weeks. Among referral letters, documentation of arthralgia duration, morning stiffness or joint examination findings was uncommon (31%, 20.5% and 56.7%, respectively).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>We identified positive and negative predictors of IA. Referral letters often missed key information required for the triaging process. Future efforts will be directed towards build a triaging tool to improve the referral quality and capture of those patients with IA who need earlier access to rheumatology care.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/rap\/rkad067","type":"journal-article","created":{"date-parts":[[2023,8,2]],"date-time":"2023-08-02T20:15:13Z","timestamp":1691007313000},"source":"Crossref","is-referenced-by-count":11,"title":["Predictors of inflammatory arthritis among new rheumatology referrals: a cross-sectional study"],"prefix":"10.1093","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2845-6574","authenticated-orcid":false,"given":"Brendan L","family":"Thoms","sequence":"first","affiliation":[{"name":"Division of Rheumatology and Clinical Immunology, Department of Medicine, Robert Larner, MD College of Medicine at the University of Vermont and University of Vermont Medical Center , Burlington, VT, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Levi N","family":"Bonnell","sequence":"additional","affiliation":[{"name":"Department of General Internal Medicine Research, Robert Larner, MD College of Medicine at the University of Vermont and University of Vermont Medical Center , Burlington, VT, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bradley","family":"Tompkins","sequence":"additional","affiliation":[{"name":"Quality Program, Department of Medicine, Robert Larner, MD College of Medicine at the University of Vermont and University of Vermont Medical Center , Burlington, VT, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alana","family":"Nevares","sequence":"additional","affiliation":[{"name":"Division of Rheumatology and Clinical Immunology, Department of Medicine, Robert Larner, MD College of Medicine at the University of Vermont and University of Vermont Medical Center , Burlington, VT, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"ChiChi","family":"Lau","sequence":"additional","affiliation":[{"name":"Division of Rheumatology and Clinical Immunology, Department of Medicine, Robert Larner, MD College of Medicine at the University of Vermont and University of Vermont Medical Center , Burlington, VT, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2023,8,3]]},"reference":[{"key":"2023082707262137200_rkad067-B1","doi-asserted-by":"crossref","first-page":"446","DOI":"10.1016\/S0002-9343(01)00872-5","article-title":"Early versus delayed treatment in patients with recent-onset rheumatoid arthritis: comparison of two cohorts who received different treatment strategies","volume":"111","author":"Lard","year":"2001","journal-title":"Am J Med"},{"key":"2023082707262137200_rkad067-B2","doi-asserted-by":"crossref","first-page":"906","DOI":"10.1093\/rheumatology\/keh199","article-title":"Benefit of very early referral and very early therapy with disease-modifying anti-rheumatic drugs in patients with early rheumatoid arthritis","volume":"43","author":"Nell","year":"2004","journal-title":"Rheumatology (Oxford)"},{"key":"2023082707262137200_rkad067-B3","doi-asserted-by":"crossref","first-page":"e332","DOI":"10.1016\/S2665-9913(20)30061-8","article-title":"Referring early arthritis patients within 6 weeks versus 12 weeks after symptom onset: an observational cohort study","volume":"2","author":"Niemantsverdriet","year":"2020","journal-title":"Lancet Rheumatol"},{"key":"2023082707262137200_rkad067-B4","doi-asserted-by":"crossref","first-page":"1045","DOI":"10.1136\/annrheumdis-2013-204858","article-title":"Diagnostic delay of more than 6 months contributes to poor radiographic and functional outcome in psoriatic arthritis","volume":"74","author":"Haroon","year":"2015","journal-title":"Ann Rheum Dis"},{"key":"2023082707262137200_rkad067-B5","doi-asserted-by":"crossref","first-page":"778","DOI":"10.1002\/1529-0131(199805)41:5<778::AID-ART4>3.0.CO;2-V","article-title":"Estimates of the prevalence of arthritis and selected musculoskeletal disorders in the United States","volume":"41","author":"Lawrence","year":"1998","journal-title":"Arthritis Rheum"},{"key":"2023082707262137200_rkad067-B6","doi-asserted-by":"crossref","first-page":"bjgp20X711497","DOI":"10.3399\/bjgp20X711497","article-title":"The prevalence of musculoskeletal presentations in general practice: an epidemiological study","volume":"70(Suppl 1)","author":"Keavy","year":"2020","journal-title":"Br J Gen Pract"},{"key":"2023082707262137200_rkad067-B7","doi-asserted-by":"crossref","first-page":"851","DOI":"10.1002\/art.10202","article-title":"Urgent care and tight control of rheumatoid arthritis as in diabetes and hypertension: better treatments but a shortage of rheumatologists","volume":"46","author":"Pincus","year":"2002","journal-title":"Arthritis Rheum"},{"key":"2023082707262137200_rkad067-B8","doi-asserted-by":"crossref","first-page":"E205","DOI":"10.9778\/cmajo.20150116","article-title":"Wait times to rheumatology care for patients with rheumatic diseases: a data linkage study of primary care electronic medical records and administrative data","volume":"4","author":"Widdifield","year":"2016","journal-title":"CMAJ Open"},{"key":"2023082707262137200_rkad067-B9","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1097\/BOR.0000000000000694","article-title":"Rural health issues in rheumatology: a review","volume":"32","author":"Lennep","year":"2020","journal-title":"Curr Opin Rheumatol"},{"key":"2023082707262137200_rkad067-B10","doi-asserted-by":"crossref","first-page":"1325","DOI":"10.1136\/bmj.329.7478.1325","article-title":"Improved access and targeting of musculoskeletal services in northwest Wales: targeted early access to musculoskeletal services (TEAMS) programme","volume":"329","author":"Maddison","year":"2004","journal-title":"BMJ"},{"key":"2023082707262137200_rkad067-B11","doi-asserted-by":"crossref","first-page":"1547","DOI":"10.1002\/acr.22845","article-title":"Improving appropriate access to care with central referral and triage in rheumatology","volume":"68","author":"Hazlewood","year":"2016","journal-title":"Arthritis Care Res (Hoboken)"},{"key":"2023082707262137200_rkad067-B12","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1002\/art.20239","article-title":"\u201cThe rheumatologist can see you now\u201d: successful implementation of an advanced access model in a rheumatology practice","volume":"51","author":"Newman","year":"2004","journal-title":"Arthritis Rheum"},{"key":"2023082707262137200_rkad067-B13","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1002\/1529-0131(200106)45:3<295::AID-ART263>3.0.CO;2-3","article-title":"Pre-appointment management of new patient referrals in rheumatology: a key strategy for improving health care delivery","volume":"45","author":"Harrington","year":"2001","journal-title":"Arthritis Rheum"},{"key":"2023082707262137200_rkad067-B14","doi-asserted-by":"crossref","first-page":"369","DOI":"10.1093\/rheumatology\/39.4.369","article-title":"Does waiting matter? A randomized controlled trial of new non-urgent rheumatology out-patient referrals","volume":"39","author":"Hurst","year":"2000","journal-title":"Rheumatology (Oxford)"},{"key":"2023082707262137200_rkad067-B15","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1136\/ard.62.2.187","article-title":"Evaluation of a screening tool for inflammatory joint disease","volume":"62","author":"Barbour","year":"2003","journal-title":"Ann Rheum Dis"},{"key":"2023082707262137200_rkad067-B16","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1007\/s00296-007-0382-x","article-title":"Observational study of a patient and doctor directed pre-referral questionnaire for an early arthritis clinic","volume":"28","author":"Arndt","year":"2007","journal-title":"Rheumatol Int"},{"key":"2023082707262137200_rkad067-B17","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1002\/acr.20366","article-title":"Relative urgency for referral from primary care to rheumatologists: the Priority Referral Score","volume":"63","author":"Fitzgerald","year":"2011","journal-title":"Arthritis Care Res (Hoboken)"},{"key":"2023082707262137200_rkad067-B18","doi-asserted-by":"crossref","first-page":"1980","DOI":"10.3899\/jrheum.140167","article-title":"Comprehensive arthritis referral study \u2013 phase 2: analysis of the comprehensive arthritis referral tool","volume":"41","author":"Thompson","year":"2014","journal-title":"J Rheumatol"},{"key":"2023082707262137200_rkad067-B19","doi-asserted-by":"crossref","first-page":"497","DOI":"10.1136\/ard.2008.089441","article-title":"Development and initial validation of a screening questionnaire for psoriatic arthritis: the Toronto Psoriatic Arthritis Screen (ToPAS)","volume":"68","author":"Gladman","year":"2009","journal-title":"Ann Rheum Dis"},{"key":"2023082707262137200_rkad067-B20","doi-asserted-by":"crossref","first-page":"1950","DOI":"10.1111\/jdv.14861","article-title":"Psoriatic arthritis screening by the dermatologist: development and first validation of the \u2018PURE-4 scale\u2019","volume":"32","author":"Audureau","year":"2018","journal-title":"J Eur Acad Dermatol Venereol"},{"key":"2023082707262137200_rkad067-B21","doi-asserted-by":"crossref","first-page":"491","DOI":"10.1136\/annrheumdis-2016-209846","article-title":"EULAR definition of arthralgia suspicious for progression to rheumatoid arthritis","volume":"76","author":"van Steenbergen","year":"2017","journal-title":"Ann Rheum Dis"},{"key":"2023082707262137200_rkad067-B22","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1186\/1471-2474-11-50","article-title":"Development of a self-administered early inflammatory arthritis detection tool","volume":"11","author":"Bell","year":"2010","journal-title":"BMC Musculoskelet Disord"},{"key":"2023082707262137200_rkad067-B23","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1002\/art.1780310302","article-title":"The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis","volume":"31","author":"Arnett","year":"1988","journal-title":"Arthritis Rheum"},{"key":"2023082707262137200_rkad067-B24","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1136\/ard.59.3.223","article-title":"Predictors of functional status in patients with early rheumatoid arthritis","volume":"59","author":"Jansen","year":"2000","journal-title":"Ann Rheum Dis"},{"key":"2023082707262137200_rkad067-B25","doi-asserted-by":"crossref","first-page":"763","DOI":"10.1093\/rheumatology\/keg213","article-title":"Can diagnostic triage by general practitioners or rheumatology nurses improve the positive predictive value of referrals to early arthritis clinics?","volume":"42","author":"Gormley","year":"2003","journal-title":"Rheumatology (Oxford)"},{"key":"2023082707262137200_rkad067-B26","doi-asserted-by":"crossref","first-page":"2569","DOI":"10.1002\/art.27584","article-title":"2010 Rheumatoid arthritis classification criteria: an American College of Rheumatology\/European League Against Rheumatism collaborative initiative","volume":"62","author":"Aletaha","year":"2010","journal-title":"Arthritis Rheum"},{"key":"2023082707262137200_rkad067-B27","doi-asserted-by":"crossref","first-page":"600","DOI":"10.1002\/acr.20140","article-title":"The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity","volume":"62","author":"Wolfe","year":"2010","journal-title":"Arthritis Care Res (Hoboken)"},{"key":"2023082707262137200_rkad067-B28","doi-asserted-by":"crossref","first-page":"1115","DOI":"10.1007\/s00296-014-3208-7","article-title":"Fibrofog and fibromyalgia: a narrative review and implications for clinical practice","volume":"35","author":"Kravitz","year":"2015","journal-title":"Rheumatol Int"},{"key":"2023082707262137200_rkad067-B29","doi-asserted-by":"crossref","first-page":"939","DOI":"10.1001\/archopht.1976.03910030473007","article-title":"Erythrocyte sedimentation rate and age","volume":"94","author":"Hayes","year":"1976","journal-title":"Arch Ophthalmol"},{"key":"2023082707262137200_rkad067-B30","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1136\/bmj.286.6361.266","article-title":"Simple rule for calculating normal erythrocyte sedimentation rate","volume":"286","author":"Miller","year":"1983","journal-title":"Br Med J (Clin Res Ed)"},{"key":"2023082707262137200_rkad067-B31","doi-asserted-by":"crossref","first-page":"621","DOI":"10.1038\/ncpcardio1322","article-title":"The use of high-sensitivity assays for C-reactive protein in clinical practice","volume":"5","author":"Musunuru","year":"2008","journal-title":"Nat Clin Pract Cardiovasc Med"},{"key":"2023082707262137200_rkad067-B32","first-page":"1095","article-title":"High sensitivity C-reactive protein as a disease activity marker in rheumatoid arthritis","volume":"31","author":"Dessein","year":"2004","journal-title":"J Rheumatol"},{"key":"2023082707262137200_rkad067-B33","doi-asserted-by":"crossref","first-page":"2773","DOI":"10.1002\/art.38097","article-title":"Familial risks and heritability of rheumatoid arthritis: role of rheumatoid factor\/anti-citrullinated protein antibody status, number and type of affected relatives, sex, and age","volume":"65","author":"Frisell","year":"2013","journal-title":"Arthritis Rheum"},{"key":"2023082707262137200_rkad067-B34","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1111\/1346-8138.13157","article-title":"Effect of a family history of psoriasis and age on comorbidities and quality of life in patients with moderate to severe psoriasis: Results from the ARIZONA study","volume":"43","author":"L\u00f3pez-Estebaranz","year":"2016","journal-title":"J Dermatol"},{"key":"2023082707262137200_rkad067-B35","doi-asserted-by":"crossref","first-page":"e024361","DOI":"10.1136\/bmjopen-2018-024361","article-title":"Delays between the onset of symptoms and first rheumatology consultation in patients with rheumatoid arthritis in the UK: an observational study","volume":"9","author":"Stack","year":"2019","journal-title":"BMJ Open"},{"key":"2023082707262137200_rkad067-B36","first-page":"1378","article-title":"Triage of referrals to an outpatient rheumatology clinic: analysis of referral information and triage","volume":"35","author":"Graydon","year":"2008","journal-title":"J Rheumatol"},{"key":"2023082707262137200_rkad067-B37","doi-asserted-by":"crossref","first-page":"450","DOI":"10.1007\/s100670070004","article-title":"Referrals from general practice to an outpatient rheumatology clinic: disease spectrum and analysis of referral letters","volume":"19","author":"Gran","year":"2000","journal-title":"Clin Rheumatol"},{"key":"2023082707262137200_rkad067-B38","doi-asserted-by":"crossref","first-page":"i157","DOI":"10.1093\/rheumatology\/keu121.018","article-title":"262. A survey of perceived competency in rheumatological and musculoskeletal practice in GP St3S at the end of their training","volume":"53(Suppl 1)","author":"Warburton","year":"2014","journal-title":"Rheumatology (Oxford)"},{"key":"2023082707262137200_rkad067-B39","first-page":"945","article-title":"Confidence of graduating family practice residents in their management of musculoskeletal conditions","volume":"29","author":"Matheny","year":"2000","journal-title":"Am J Orthop (Belle Mead NJ)"},{"key":"2023082707262137200_rkad067-B40","doi-asserted-by":"crossref","first-page":"638","DOI":"10.1136\/ard.60.6.638b","article-title":"Can rheumatologists agree on a diagnosis of inflammatory arthritis in an early synovitis clinic?","volume":"60","author":"Gormley","year":"2001","journal-title":"Ann Rheum Dis"}],"container-title":["Rheumatology Advances in Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/rheumap\/advance-article-pdf\/doi\/10.1093\/rap\/rkad067\/51032342\/rkad067.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/rheumap\/article-pdf\/7\/3\/rkad067\/51274367\/rkad067.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/rheumap\/article-pdf\/7\/3\/rkad067\/51274367\/rkad067.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,27]],"date-time":"2023-08-27T07:26:39Z","timestamp":1693121199000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/rheumap\/article\/doi\/10.1093\/rap\/rkad067\/7236509"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,1,1]]},"references-count":40,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2023,8,26]]}},"URL":"https:\/\/doi.org\/10.1093\/rap\/rkad067","relation":{},"ISSN":["2514-1775"],"issn-type":[{"value":"2514-1775","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2023,1,1]]},"published":{"date-parts":[[2023,1,1]]},"article-number":"rkad067"}}