AB0695 A PATIENT REPORTED-OUTCOMES REFERRAL TOOL TO IDENTIFY PATIENTS WITH RHEUMATOID ARTHRITIS AND FACILITATE EARLY REFERRAL FROM PRIMARY CARE TO RHEUMATOLOGY
Authors: I. Castrejon, C. Bourgeois, M. T. Schiaffino, T. Del Río Blasco, M. Sánchez Lucas, J. Molina-Collada, J. Martínez-Barrio, J. Rivera, J. M. Alvaro-Gracia
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> Early referral to rheumatology of patients with arthritis is recommended for an early diagnosis of rheumatoid arthritis (RA) to initiate treatment during the window of opportunity<sup>1</sup>. However, the insidious onset, non-specific symptoms early in the disease, and the lack of confidence to diagnose RA are challenges for primary care physicians (PCPs) in our area in order to adequately refer patients as we evaluated in a previous survey<sup>2</sup>. <h3>Objectives:</h3> We aimed to evaluate a referral tool based on patient reported outcomes (PROs), easily completed by patients, to guide PCPs and support referral of patients with suspected RA. <h3>Methods:</h3> A one-day a week Early Arthritis Clinic (EAC) with fast and direct access for PCPs (180 in 11 primary care centres) has been established from January 2022. Referral criteria are clinical, and in consensus with a PCP committee: &gt;2 swollen joints, duration of symptoms &lt;2 years, and no previous rheumatology diagnosis. At baseline, patients complete two questionnaires on a tablet, a referral form based on PROs including affected joints, symmetry, morning stiffness in minutes, age and family history of RA and a multidimensional health assessment questionnaire (MDHAQ). Physical exam and laboratory tests are performed at baseline. A descriptive analysis by diagnostic group is presented. Receiver operating characteristic (ROC) analysis were performed to evaluate the ability of the referral form to discriminate RA. <h3>Results:</h3> From 328 patients referred to our EAC up to November 2023, only 70 (21%) fulfilled the inclusion criteria: 23 (33%) with undifferentiated arthritis (UA), 24 (34%) with RA, 17 (24%) with spondyloarthritis including psoriatic arthritis, and 6 (9%) with other diagnosis. Patients in the RA group were older, more frequently female, with positive ACPA and rheumatoid factor, and presented higher levels of CRP (Table 1). Disease activity according to DAS28 and CDAI was higher in the RA group, but according to RAPID3 higher in the spondyloarthritis group. The ability to discriminate between RA and other diagnosis was comparable for the referral score based on PROs (AUC: 0.59 95%CI (0.43-0.75) versus DAS28-CRP (AUC: 0.43 95%CI (0.26-0.61) and CDAI (AUC: 0.56 95%CI (0.38-0.74) which require a physician's global assessment of disease activity and joint counts by the physician. The cut-off of 18 presented the best combination of sensibility 43%, specificity 89% and likelihood ratio for a positive test 3.8. <h3>Conclusion:</h3> Our results show poor quality of referral to our EAC with only 21% patients fulfilling criteria to be evaluated, highlighting the need for tools to guide PCPs. The PROMs-referral tool is easily completed by patients on a tablet, discriminate patients with RA, and may be useful for PCPs for an early referral of patients with suspected RA. <h3>REFERENCES:</h3> [1] van Steenbergen HW, et al. Ann Rheum Dis 2017;76:491–496. 2. Bourgeois C, et al. Ann Rheum Dis 2023. volume 82, supplement 1, page 89 <h3>Acknowledgements:</h3> NIL.This work was supported by the following grants: PI20/00847, PI23/01226 and RD21/0002/0034 from Instituto de Salud Carlos III and co-financed by the European Regional Development Fund. <h3>Disclosure of Interests:</h3> <b>None declared.</b>