Design of an algorithm for the diagnostic approach of patients with joint pain
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ORIGINAL ARTICLE
Design of an algorithm for the diagnostic approach of patients with joint pain Daniel G. Fernández-Ávila 1 & María Ximena Rojas 2 & Sergio A. Mora 3 & Paola Varela Rojas 4 & Lucía Vanegas-García 5 & Ana María Sapag-Durán 6 & Andrés Alberto Hormaza 7 & Andres Ricardo Fernández 8 & Antonio Cachafeiro-Vilar 9 & Belia Lucía Meléndez 10 & Carlo V. Caballero-Uribe 11 & Carlos Enrique Toro-Gutiérrez 12 & Daniel Rubén Palleiro-Rivero 13 & Diego Alejandro Jaimes-Fernández 14 & Dina Maria Arrieta 15 & Fausto Álvarez 16 & Gineth Paola Pinto-Patarroyo 17 & Guillermo Andrés Quiceno 18 & Guillermo Pons-Estel 19 & Jose A. Gómez Puerta 20 & Jossiell Then Báez 21 & Juan Manuel Bello-Gualtero 22 & Juan Martín Gutiérrez 23 & Juan Sebastian Segura 24 & Leandro Gabriel Ferreyra 25 & Lilith Stange 26 & Lina Maria Saldarriaga 27 & Manuel Francisco Ugarte-Gil 28 & Mario H. Cardiel 29 & Mario Javier Moreno 30 & Maritza Quintero 31 & Marlon B. Porras 32 & Nelly Colman 33 & Nilmo Noel Chávez 34 & Oscar Orlando Ruiz 4 & Paul Méndez-Patarroyo 35 & Ricardo Machado-Xavier 36 & Tomás Caicedo 37 & Vanessa Ocampo 38 & Wilson Armando Bautista-Molano 39 & Yimy F. Medina 40 & Yurilis Josefina Fuentes-Silva 41 & Enrique R. Soriano 25 Received: 6 May 2020 / Revised: 20 July 2020 / Accepted: 4 August 2020 # International League of Associations for Rheumatology (ILAR) 2020
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.
Key Points • We developed an
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