Use of Rheumatologic Testing in Patients who Eventually Receive a Diagnosis of Rheumatoid Arthritis

Dilpreet K. Singh, MD; Jasdeep Badwal, MD; Ritika Vankina, MD; Santhi Gokaraju, MD; Jennifer Friderici, MS; Scott Halista, MD; Tara Lagu, MD, MPH


South Med J. 2019;112(10):547-550. 

In This Article


We conducted a retrospective chart review examining the primary care diagnostic workup of patients who were seen sequentially between January 1, 2010 and June 15, 2014 in two rheumatology clinics: one private practice (PP) and one community health center (CHC) associated with an academic medical center. There were no restrictions on ordering any tests by practices, and all of the diagnostic tests were available for PCPs to order during the study period. We used chart abstraction to collect demographics, insurance type, referring provider specialty, diagnostic tests, functional status, symptom duration, and treatments before and after referral. We used descriptive statistics to compare the characteristics and outcomes of patients who had ACPA performed before rheumatologist visit to those who did not. We used counts and percentages, means and standard deviations, and percentile distributions to describe patient characteristics (we calculated mean age). Test proportions were calculated with exact 95% confidence intervals (CIs). We explored associations between ACPA testing and various patient or provider characteristics using unpaired t tests (continuous) or Fisher exact tests (categorical), but these analyses should be considered exploratory because they were not the primary outcome of the study. All of the analyses were carried out using SAS statistical software (version 9.3, SAS Institute, Cary, NC). The Baystate Medical Center institutional review board determined that the project did not constitute human subjects research.