COMMENTARY

Toward Earlier Identification of Rheumatic Diseases

Kevin D. Deane, MD, PhD

Disclosures

July 12, 2017

Symptom Recognition and Perceived Urgency of Help-Seeking for Rheumatoid Arthritis and Other Diseases in the General Public: A Mixed Method Approach

Simons G, Belcher J, Morton C, et al
Arthritis Care Res (Hoboken). 2017;69:633-641

Abstract

Early Clinical Features in Systemic Lupus Erythematosus: Can They Be Used to Achieve Early Diagnosis? A Risk Prediction Model

Rees F, Doherty M, Lanyon P, et al
Arthritis Care Res (Hoboken). 2017;69:833-841

Abstract

Study Summaries

Two interesting articles recently addressed issues related to the timing of diagnosis of rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE).

In the first article, Simons and colleagues interviewed 31 people with RA and 1088 people without RA. They found that only a small number of these people recognized the symptoms of RA and, in many cases, did not realize that such symptoms could warrant urgent evaluation. Conversely, these individuals were quick to recognize symptoms of bowel cancer and heart disease and most of the time identified symptoms of these diseases as being more serious and requiring rapid medical evaluation.

In a separate study of more than 8000 individuals with and without SLE, Rees and colleagues found that individuals ultimately diagnosed with SLE had a higher frequency of visits to their primary care provider in the 5 years preceding diagnosis. The investigators developed a prediction model that included clinical features (but no laboratory tests) and was fairly discriminate for SLE (area under the curve of 0.75), although the model overall had a low positive predictive value given the low prevalence of SLE.

In their conclusions, the authors of these reports recommended that public health campaigns and predictive models applied in primary care, respectively, could improve the early diagnosis of RA and SLE.

Viewpoint

Earlier diagnosis and treatment of rheumatic diseases improves long-term outcomes. In patients with RA, early diagnosis and treatment may be associated with higher rates of drug-free remission.[1]

While effective at improving disease activity and quality of life, the current therapies for rheumatic diseases are not yet miracle cures. Thus, our best way forward with these diseases may be to minimize their adverse effects through early diagnosis tactics suggested by these studies: public awareness and prediction models that can be applied in primary care. These two approaches are particularly intriguing given the growing shortage of rheumatologists and the potential changes in access to healthcare that may be coming in the United States and elsewhere.

Of course, these approaches need to balance early disease identification against specificity for "true" rheumatic diseases. In the case of the prediction model for SLE, perhaps the judicious addition of accurate biomarkers could help improve the specificity of prediction. In addition, these approaches need to be cost-effective.

Both studies are to be applauded for their efforts to move us toward earlier identification of rheumatic disease. Let's hope that the next steps will include further work that improves, refines, and implements early identification methods for rheumatic disease and ultimately leads to improved long-term outcomes.

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