GPs and Rheumatologists Show Poor Agreement on Rheumatic Disease Diagnoses

A cohort study aimed to evaluate differences in diagnoses of rheumatic diseases between health care practitioners found that diagnosis and treatment were somewhat challenging for general practitioners (GPs). The findings of the paper are published in the Journal of Clinical Rheumatology.

“The aim of this study was to evaluate the concordance of the diagnoses made by senior rheumatologists and those made by residents in rheumatology and by GPs,” the authors wrote. “We found a poor level of diagnostic agreement between GPs and the rheumatology team.”

The study included 497 patients referred by GPs from August 2018 to December 2019. A second-year rheumatology resident conducted the first round of evaluations, and senior rheumatologists provided the final diagnoses. The conclusions of experienced rheumatologists were taken to be the ultimate benchmark for defining the incidence of rheumatoid arthritis, spondyloarthritis, nonautoimmune rheumatic diseases, nonrheumatic diseases, and other connective tissue diseases and vasculitis. The last day for follow-up visits was November 30, 2020.

In 58% of the referral letters, the diagnoses were modified. Half of the diagnoses were attributed to diseases like fibromyalgia and osteoarthritis. Compared to senior rheumatologists, residents in rheumatology (κ > 0.6) performed better than GPs (κ < 0.5). GPs provided the least accurate diagnoses in the nonautoimmune rheumatic disease (κ = −0.18) and nonrheumatic disease categories (κ = 0.15).

In general, researchers found “a poor level of diagnostic agreement between GPs and the rheumatology team.” GPs generally found it difficult to arrive at a correct diagnosis and provide a good treatment plan for patients with rheumatic diseases. The investigators concluded that 1 year of training brought the diagnostic skills of rheumatology residents close to those of experienced rheumatologists.

—Priyam Vora

Reference:
Teixeira F, Eugenia M, Musse S et al. Diagnostic agreement among general practitioners, residents, and senior rheumatologists for rheumatic diseases. Clin Rheumatol. 2022: 28(6); 293-299. DOI: 10.1097/RHU.0000000000001854