title: How do general practitioners identify inflammatory arthritis? A cohort analysis of Dutch general practitioner electronic medical records.
abstract: OBJECTIVE
  To examine the symptoms, signs and additional investigations that general practitioners (GPs) used in the process of diagnosing recent-onset inflammatory arthritis. Here, we assumed that the recorded information was crucial in the diagnostic process of arthritis.
  
  
  METHODS
  A database including electronic medical records of 16 Dutch general practices with 44,350 patients was studied. Patients with an episode of RA and allied conditions according to the International Classification of Primary Care-1 code L88 (here summarized as inflammatory arthritis) in the period 2009-2013 were selected. Frequencies of symptoms, signs and performed additional investigations were evaluated and compared between referred and non-referred patients.
  
  
  RESULTS
  A total of 126 patients were diagnosed with inflammatory arthritis. Information on symptom duration, symptom location, swelling, loss of function, redness and warmth were recorded in, respectively, 64, 90, 80, 52, 48 and 41% of patients. Information on morning stiffness, family history or the squeeze-test was provided in 20, 18 and 17% of patients. Symmetry, inflammatory type arthralgia and fist closure were not recorded. Acute phase reactants and auto-antibody tests were performed in 40-46% and 8-11%, respectively. Eighty-four patients (67%) were referred to secondary care. Symptoms located in the foot, morning stiffness, family history, myalgia, absence of redness and elevated acute phase reactants were associated with referral (all P < 0.05).
  
  
  CONCLUSIONS
  GPs mainly used classical signs of inflammation to diagnose inflammatory arthritis. Other items that are regularly assessed in secondary care (morning stiffness, squeeze-test, family history) were infrequently recorded by GPs.
authors.affiliation: Department of Rheumatology and.
authors.forename: Elize C
authors.initials: EC
authors.lastname: Newsum
authors.affiliation: Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, the Netherlands.
authors.forename: Margot W M
authors.initials: MW
authors.lastname: de Waal
authors.affiliation: Department of Rheumatology and.
authors.forename: Hanna W
authors.initials: HW
authors.lastname: van Steenbergen
authors.affiliation: Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, the Netherlands.
authors.forename: Jacobijn
authors.initials: J
authors.lastname: Gussekloo
authors.affiliation: Department of Rheumatology and Avdhelm@lumc.nl.
authors.forename: Annette H M
authors.initials: AH
authors.lastname: van der Helm-van Mil
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000175:diagnosis*; D015415:Biomarkers / Q000097:blood; D015331:Cohort Studies; D016208:Databases, Factual; D042241:Early Diagnosis; D057286:Electronic Health Records; D005260:Female; D058006:General Practice / Q000379:methods*; D006801:Humans; D007249:Inflammation / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D011364:Professional Practice / Q000706:statistics & numerical data; D012017:Referral and Consultation / Q000706:statistics & numerical data; D055815:Young Adult
chemical_list: D015415:Biomarkers
keywords: general practitioner; inflammatory arthritis; referral to secondary care; symptoms and signs