{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T19:04:14Z","timestamp":1782846254114,"version":"3.54.5"},"reference-count":37,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JMIR Med Inform"],"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n Inflammatory rheumatic diseases (IRDs) affect 5% of the general population, whereas 35% of the population experiences musculoskeletal concerns. IRDs cause early disability, reduced life expectancy, and considerable health care costs. Early diagnosis is essential to prevent long-term damage. Similarly important is the early identification of patients with musculoskeletal concerns without IRDs to prevent unnecessary health care expenses. Of the population referred to the rheumatologist, 60% have noninflammatory musculoskeletal concerns, whereas only 20% of patients with an IRD see a rheumatologist within 3 months of symptom onset. The need for digital predictive (triage) tools for rheumatic and musculoskeletal diseases led to the development of the Frysian Questionnaire for Differentiation of Musculoskeletal Complaints (FRYQ).<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n This study aimed to assess whether the FRYQ can distinguish IRD from noninflammatory musculoskeletal concerns in general, and rheumatoid arthritis and fibromyalgia specifically, in newly referred patients.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n The FRYQ is an 87-item tool (20 open-ended and 67 closed-ended questions) used to triage new rheumatology patients at Frisius Medical Center in the Netherlands. We analyzed data from 2 sources: dataset A with 728 outpatient clinic patients and dataset B with 373 patients from the Joint Pain Assessment Scoring Tool study. We built a classifier using Extreme Gradient Boosting to distinguish inflammatory from noninflammatory conditions based on closed-ended questions. Using elastic net regularization, we identified the most informative questions. We evaluated classification using receiver operating characteristic curve analysis and assessed feature importance through Shapley Additive Explanation analysis. To test generalizability, we replicated our analysis on dataset B. Finally, we examined whether the questions of the FRYQ could be used to identify specific conditions beyond the general categories of IRD and non-IRD, specifically for detecting fibromyalgia and rheumatoid arthritis.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Feature selection reduced the questionnaire from 67 to 28 items while maintaining discriminative power. After initial development, the model achieved an area under the receiver operating characteristic curve (AUC-ROC) of 0.72 (95% CI 0.67-0.78) for distinguishing inflammatory from noninflammatory conditions in an external validation set. Using a probability threshold of 0.30, the model achieved 71% sensitivity and 56% specificity on external validation. The FRYQ demonstrated stronger performance in identifying specific diagnoses such as fibromyalgia (AUC-ROC=0.81) and rheumatoid arthritis (AUC-ROC=0.77). Key discriminating features included symptom duration, pain response to movement, and anti-inflammatory medication effectiveness.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n The FRYQ effectively distinguishes inflammatory from noninflammatory rheumatic conditions before specialist consultation and shows particular strength in identifying fibromyalgia and rheumatoid arthritis. This tool could improve rheumatology triage by prioritizing referrals with high likelihood of IRD for early rheumatologist evaluation while directing other patients to appropriate alternative resources. Prospective studies are needed to determine the FRYQ\u2019s impact on clinical outcomes and health care efficiency.<\/jats:p>\n <\/jats:sec>","DOI":"10.2196\/77345","type":"journal-article","created":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T13:45:07Z","timestamp":1759326307000},"page":"e77345-e77345","source":"Crossref","is-referenced-by-count":0,"title":["Evaluating the Accuracy of the Frysian Questionnaire for Differentiation of Musculoskeletal Complaints for Triage of Musculoskeletal Diseases: Algorithm Development and Validation Study"],"prefix":"10.2196","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1701-1040","authenticated-orcid":false,"given":"Tjardo Dani\u00ebl","family":"Maarseveen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6522-844X","authenticated-orcid":false,"given":"Floor","family":"Reimann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7462-5167","authenticated-orcid":false,"given":"Ahmed","family":"al Hasan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-9946-1502","authenticated-orcid":false,"given":"Annemarie","family":"Schilder","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-2024-5979","authenticated-orcid":false,"given":"Dan","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0319-1247","authenticated-orcid":false,"given":"Freke","family":"Wink","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-4075-8312","authenticated-orcid":false,"given":"Lidy","family":"Hendriks","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7494-3023","authenticated-orcid":false,"given":"Rachel","family":"Knevel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1094-5596","authenticated-orcid":false,"given":"Reinhard","family":"Bos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2025,11,17]]},"reference":[{"key":"R1","unstructured":"van der Linden MW Westert GP Schellevis F . Tweede nationale studie naar ziekten en verrichtingen in de huisartspraktijk: klachten en aandoeningen in de bevolking en in de huisartspraktijk [Report in Dutch]. NIVEL\/RIVM; 2004. URL: https:\/\/www.nivel.nl\/sites\/default\/files\/bestanden\/ns2_r1_h02.pdf [Accessed 05-11-2025]"},{"issue":"10258","key":"R2","doi-asserted-by":"publisher","first-page":"1204","DOI":"10.1016\/S0140-6736(20)30925-9","article-title":"Global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019: a systematic analysis for the global burden of disease study 2019","volume":"396","author":"GBD 2019 Diseases and Injuries Collaborators","journal-title":"Lancet"},{"key":"R3","unstructured":"NHG-richtlijnen [Web page in Dutch]. Nederlands Huisartsen Genootschap. 2023. URL: https:\/\/richtlijnen.nhg.org\/ [Accessed 28-07-2025]"},{"issue":"4","key":"R4","doi-asserted-by":"publisher","first-page":"1493","DOI":"10.1007\/s40744-021-00365-1","article-title":"Differentiating psoriatic arthritis from osteoarthritis and rheumatoid arthritis: a narrative review and guide for advanced practice providers","volume":"8","author":"Saalfeld","journal-title":"Rheumatol Ther"},{"issue":"7","key":"R5","doi-asserted-by":"publisher","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","journal-title":"Rheumatology (Oxford)"},{"issue":"1746","key":"R6","first-page":"21","volume":"255","author":"Malaviya","journal-title":"Practitioner"},{"issue":"12","key":"R7","doi-asserted-by":"publisher","first-page":"3537","DOI":"10.1002\/art.27692","article-title":"Long-term impact of delay in assessment of patients with early arthritis","volume":"62","author":"van der Linden","journal-title":"Arthritis Rheum"},{"key":"R8","unstructured":"Spending on health care up by 8.1 percent in 2024. Centraal Bureau voor de Statistiek. 2025. URL: https:\/\/www.cbs.nl\/en-gb\/news\/2025\/22\/spending-on-health-care-up-by-8-1-percent-in-2024 [Accessed 29-08-2025]"},{"key":"R9","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2474-4-3","article-title":"Determinants of the clinical course of musculoskeletal complaints in general practice: design of a cohort study","volume":"4","author":"van der Waal","journal-title":"BMC Musculoskelet Disord"},{"issue":"3","key":"R10","doi-asserted-by":"publisher","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","journal-title":"BMJ Open"},{"issue":"10","key":"R11","doi-asserted-by":"publisher","first-page":"1822","DOI":"10.1136\/ard.2011.151902","article-title":"Delays in assessment of patients with rheumatoid arthritis: variations across Europe","volume":"70","author":"Raza","journal-title":"Ann Rheum Dis"},{"issue":"5","key":"R12","doi-asserted-by":"publisher","DOI":"10.2196\/17507","article-title":"Toward earlier diagnosis using combined eHealth tools in rheumatology: the joint pain assessment scoring tool (JPAST) project","volume":"8","author":"Knitza","journal-title":"JMIR Mhealth Uhealth"},{"key":"R13","unstructured":"Act of 26 February 1998 on medical-scientific research involving human subjects (Medical Research Involving Human Subjects Act, WMO). Dutch Official Gazette. 1998. URL: https:\/\/wetten.overheid.nl\/BWBR0009408\/2025-01-01 [Accessed 04-11-2025]"},{"key":"R14","unstructured":"Snoek J Larochelle H Adams RP . Practical Bayesian optimization of machine learning algorithms. arXiv. Preprint posted online on Jun 13, 2012. [doi: 10.48550\/arXiv.1206.2944]"},{"key":"R15","doi-asserted-by":"crossref","unstructured":"Chen T Guestrin C . XGBoost: a scalable tree boosting system. In: Krishnapuram B Shah M , editors. KDD \u201916: Proceedings of the 22nd ACM SIGKDD International Conference on Knowledge Discovery and Data Mining. 785-794. [doi: 10.1145\/2939672.2939785] ISBN: 9781450342322","DOI":"10.1145\/2939672.2939785"},{"key":"R16","unstructured":"Grinsztajn L Oyallon E Varoquaux G . Why do tree-based models still outperform deep learning on typical tabular data. In: Koyejo S Mohamed S Agarwal A Belgrave D Cho K Oh A , editors. NIPS \u201922: Proceedings of the 36th International Conference on Neural Information Processing Systems. 2022:507-520. ISBN: 9781713871088"},{"key":"R17","doi-asserted-by":"crossref","unstructured":"Roth AE , editor. The Shapley Value: Essays in Honor of Lloyd S Shapley. Cambridge: Cambridge University Press; 1988. [doi: 10.1017\/CBO9780511528446] ISBN: 9780511528446","DOI":"10.1017\/CBO9780511528446"},{"issue":"6","key":"R18","doi-asserted-by":"publisher","first-page":"555","DOI":"10.3899\/jrheum.220300","article-title":"The challenge of addressing the rheumatology workforce shortage","volume":"49","author":"Miloslavsky","journal-title":"J Rheumatol"},{"issue":"7","key":"R19","first-page":"1378","volume":"35","author":"Graydon","journal-title":"J Rheumatol"},{"issue":"1","key":"R20","doi-asserted-by":"publisher","DOI":"10.1093\/rap\/rkaa005","article-title":"Applied machine learning and artificial intelligence in rheumatology","volume":"4","author":"H\u00fcgle","journal-title":"Rheumatol Adv Pract"},{"issue":"1","key":"R21","doi-asserted-by":"publisher","DOI":"10.1186\/s13075-021-02498-8","article-title":"Accuracy, patient-perceived usability, and acceptance of two symptom checkers (Ada and Rheport) in rheumatology: interim results from a randomized controlled crossover trial","volume":"23","author":"Knitza","journal-title":"Arthritis Res Ther"},{"issue":"5","key":"R22","doi-asserted-by":"publisher","first-page":"338","DOI":"10.2340\/16501977-0334","article-title":"A six-week hand exercise programme improves strength and hand function in patients with rheumatoid arthritis","volume":"41","author":"Brorsson","journal-title":"J Rehabil Med"},{"issue":"4","key":"R23","doi-asserted-by":"publisher","first-page":"410","DOI":"10.1093\/rheumatology\/ken511","article-title":"A dynamic exercise programme to improve patients\u2019 disability in rheumatoid arthritis: a prospective randomized controlled trial","volume":"48","author":"Baillet","journal-title":"Rheumatology (Oxford)"},{"issue":"Suppl 3","key":"R24","doi-asserted-by":"publisher","DOI":"10.1186\/ar4174","article-title":"Use of NSAIDs in treating patients with arthritis","volume":"15 Suppl 3","author":"Crofford","journal-title":"Arthritis Res Ther"},{"issue":"12","key":"R25","doi-asserted-by":"publisher","first-page":"1307","DOI":"10.1080\/003655201317097173","article-title":"Musculoskeletal manifestations in a population-based cohort of inflammatory bowel disease patients","volume":"36","author":"Salvarani","journal-title":"Scand J Gastroenterol"},{"issue":"4","key":"R26","doi-asserted-by":"publisher","DOI":"10.1007\/s11916-016-0556-x","article-title":"Fibromyalgia pathogenesis and treatment options update","volume":"20","author":"Chinn","journal-title":"Curr Pain Headache Rep"},{"key":"R27","doi-asserted-by":"publisher","DOI":"10.1016\/j.dss.2022.113899","article-title":"Improving triaging from primary care into secondary care using heterogeneous data-driven hybrid machine learning","volume":"166","author":"Wang","journal-title":"Decis Support Syst"},{"issue":"1","key":"R28","doi-asserted-by":"publisher","DOI":"10.1038\/s41746-025-01495-4","article-title":"Improving musculoskeletal care with AI enhanced triage through data driven screening of referral letters","volume":"8","author":"Maarseveen","journal-title":"NPJ Digit Med"},{"issue":"19","key":"R29","doi-asserted-by":"publisher","DOI":"10.3390\/healthcare12191948","article-title":"Patient-reported outcomes of depression and fibromyalgia symptoms do not predict non-inflammatory versus inflammatory diagnoses at initial rheumatology consultation","volume":"12","author":"Sch\u00e4fer","journal-title":"Healthcare (Basel)"},{"issue":"Suppl 1","key":"R30","doi-asserted-by":"publisher","first-page":"664","DOI":"10.1016\/j.ard.2025.05.819","article-title":"POS0433 comparison of musculoskeletal referral pathways across EUROPE","volume":"84","author":"Gomon","journal-title":"Ann Rheum Dis"},{"issue":"2","key":"R31","doi-asserted-by":"publisher","first-page":"303","DOI":"10.1007\/s00296-023-05464-6","article-title":"Diagnostic accuracy of a large language model in rheumatology: comparison of physician and ChatGPT-4","volume":"44","author":"Krusche","journal-title":"Rheumatol Int"},{"issue":"1","key":"R32","doi-asserted-by":"publisher","DOI":"10.1186\/s12911-024-02698-7","article-title":"A hybrid framework with large language models for rare disease phenotyping","volume":"24","author":"Wu","journal-title":"BMC Med Inform Decis Mak"},{"issue":"2","key":"R33","doi-asserted-by":"publisher","first-page":"438","DOI":"10.1007\/s41666-023-00155-0","article-title":"Identifying and extracting rare diseases and their phenotypes with large language models","volume":"8","author":"Shyr","journal-title":"J Healthc Inform Res"},{"issue":"3","key":"R34","doi-asserted-by":"publisher","first-page":"341","DOI":"10.13075\/ijomeh.1896.01268","article-title":"Occupational stress and musculoskeletal symptoms in firefighters","volume":"32","author":"Soteriades","journal-title":"Int J Occup Med Environ Health"},{"issue":"5","key":"R35","doi-asserted-by":"publisher","first-page":"417","DOI":"10.1016\/j.jpsychores.2003.10.013","article-title":"Work stress and incidence of newly diagnosed fibromyalgia: prospective cohort study","volume":"57","author":"Kivim\u00e4ki","journal-title":"J Psychosom Res"},{"issue":"1","key":"R36","doi-asserted-by":"publisher","first-page":"56","DOI":"10.1016\/j.jcm.2018.07.005","article-title":"Differentiating bilateral symptomatic hand osteoarthritis from rheumatoid arthritis using sonography when clinical and radiographic features are nonspecific: a case report","volume":"18","author":"Lewis","journal-title":"J Chiropr Med"},{"key":"R37","unstructured":"Maarseveen TD . FRYQ. Github. URL: https:\/\/github.com\/levrex\/FRYQ [Accessed 13-11-2025]"}],"container-title":["JMIR Medical Informatics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/medinform.jmir.org\/2025\/1\/e77345","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T18:09:29Z","timestamp":1782842969000},"score":1,"resource":{"primary":{"URL":"https:\/\/medinform.jmir.org\/2025\/1\/e77345"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,17]]},"references-count":37,"URL":"https:\/\/doi.org\/10.2196\/77345","relation":{},"ISSN":["2291-9694"],"issn-type":[{"value":"2291-9694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,17]]},"article-number":"v13i10258e77345"}}