title: [Criterios utilizados por médicos de atención primaria para el diagnóstico y derivación al reumatólogo del paciente con artritis reumatoide].
abstract: BACKGROUND
  Rheumatoid arthritis (RA), an important cause of disability, affects 1% of the population. Early diagnosis and referral to a rheumatologist are positive prognostic factor but diagnosis in many cases is in the hands of primary care physicians (PCP).
  
  
  OBJECTIVE
  To determine the criteria used by PCP for diagnosis of RA and referral of these patients to a rheumatologist; to evaluate how many cases can be classified as RA according to the ACR.
  
  
  METHODS
  Retrospective study of 530 patients referred by PCP and seen as outpatients at a rheumatology clinic in 2002. Patients with referral diagnosis of RA were identified and symptoms, signs, functional capacity and ACR criteria for RA were evaluated by 2 rheumatologists.
  
  
  RESULTS
  302 patients had a referral diagnosis of RA, 33 male (10.9%) and 269 female (89.1%), median age 50.5 years, with a median time since diagnosis of 45.2 months. 57.9% had FC stage II. 100% of cases had "generalized" joint pain, 67.5% arthritis of 3 or more joints and 51.7% arthritis of hand joints. Arthritis was symmetrical in 58.9% and 77.2% of the patients had morning stiffness (> 30 min). 49.7% of the cases had positive rheumatoid factor, 19.2% had a negative RF and 31.1% had none reported. In 2% ESR was measured. X-ray erosions were reported in 6.6% of cases. When using the ACR criteria, 17.8% of patients had 1, 28.7% had 2 and 53.5% had 3 or more criteria. In only 59 cases (20%) did the rheumatologist agree with the referral diagnosis of RA.
  
  
  CONCLUSIONS
  80% of PCP referrals of RA to the rheumatologist were another disease. A poor clinical evaluation and little support from laboratory and x-rays was noticed. The delay in diagnosis and referral was 3 years, worsening prognosis. A vigorous effort in educating PCP is needed to achieve early diagnosis and referral of RA cases.
authors.affiliation: Departamento de Reumatología. Hospital General de Cuernavaca Dr. José G. Parres. Secretaría de Salud. Cuernavaca. Morelos. México.
authors.forename: Daniel
authors.initials: D
authors.lastname: Xibillé-Friedmann
authors.forename: Victor
authors.initials: V
authors.lastname: Mondragón-Flores
authors.forename: César Horcasitas
authors.initials: CH
authors.lastname: de la Rosa