학술논문
Design of an algorithm for the diagnostic approach of patients with joint pain
Document Type
Original Paper
Author
Fernández-Ávila, Daniel G.; Rojas, María Ximena; Mora, Sergio A.; Varela Rojas, Paola; Vanegas-García, Lucía; Sapag-Durán, Ana María; Hormaza, Andrés Alberto; Fernández, Andres Ricardo; Cachafeiro-Vilar, Antonio; Meléndez, Belia Lucía; Caballero-Uribe, Carlo V.; Toro-Gutiérrez, Carlos Enrique; Palleiro-Rivero, Daniel Rubén; Jaimes-Fernández, Diego Alejandro; Arrieta, Dina Maria; Álvarez, Fausto; Pinto-Patarroyo, Gineth Paola; Quiceno, Guillermo Andrés; Pons-Estel, Guillermo; Gómez Puerta, Jose A.; Báez, Jossiell Then; Bello-Gualtero, Juan Manuel; Gutiérrez, Juan Martín; Segura, Juan Sebastian; Ferreyra, Leandro Gabriel; Stange, Lilith; Saldarriaga, Lina Maria; Ugarte-Gil, Manuel Francisco; Cardiel, Mario H.; Moreno, Mario Javier; Quintero, Maritza; Porras, Marlon B.; Colman, Nelly; Chávez, Nilmo Noel; Ruiz, Oscar Orlando; Méndez-Patarroyo, Paul; Machado-Xavier, Ricardo; Caicedo, Tomás; Ocampo, Vanessa; Bautista-Molano, Wilson Armando; Medina, Yimy F.; Fuentes-Silva, Yurilis Josefina; Soriano, Enrique R.
Source
Clinical Rheumatology: Journal of the International League of Associations for Rheumatology. 40(4):1581-1591
Subject
Language
English
ISSN
0770-3198
1434-9949
1434-9949
Abstract
Background: Rheumatic diseases are a reason for frequent consultation with primary care doctors. Unfortunately, there is a high percentage of misdiagnosis.Objective: To design an algorithm to be used by primary care physicians to improve the diagnostic approach of the patient with joint pain, and thus improve the diagnostic capacity in four rheumatic diseases.Methods: Based on the information obtained from a literature review, we identified the main symptoms, signs, and paraclinical tests related to the diagnosis of rheumatoid arthritis, spondyloarthritis with peripheral involvement, systemic lupus erythematosus with joint involvement, and osteoarthritis. We conducted 3 consultations with a group of expert rheumatologists, using the Delphi technique, to design a diagnostic algorithm that has as a starting point “joint pain” as a common symptom for the four diseases.Results: Thirty-nine rheumatologists from 18 countries of Ibero-America participated in the Delphi exercise. In the first consultation, we presented 94 items to the experts (35 symptoms, 31 signs, and 28 paraclinical tests) candidates to be part of the algorithm; 74 items (25 symptoms, 27 signs, and 22 paraclinical tests) were chosen. In the second consultation, the decision nodes of the algorithm were chosen, and in the third, its final structure was defined. The Delphi exercise lasted 8 months; 100% of the experts participated in the three consultations.Conclusion: We present an algorithm designed through an international consensus of experts, in which Delphi methodology was used, to support primary care physicians in the clinical approach to patients with joint pain.[Table Removed]