TY - JOUR
T1 - Fast track clinic for early diagnosis of polymyalgia rheumatica
T2 - Impact on symptom duration and prednisolone initiation
AU - Frølund, Line L
AU - Våben, Christoffer
AU - Dam, Mette
AU - Kjær, Søren G
AU - Nielsen, Berit D
AU - Østgård, René D
AU - Keller, Kresten K
PY - 2021/10
Y1 - 2021/10
N2 - Objectives: To evaluate the efficacy of a fast track clinic (FTC) for patients suspected of polymyalgia rheumatica (PMR) regarding symptom duration, prednisolone initiation before rheumatological assessment, number of hospital contacts before diagnosis, and cancer diagnosis. Methods: It is a retrospective cohort study with a one year follow-up period. Patients referred to the FTC (1st August 2016 to 25th June 2019) were compared to a historical cohort of PMR patients (1st August 2014 to 1st August 2016). Referral criteria are: age over 50, symptoms of PMR but not cranial GCA, and increased C-reactive protein. Data were obtained from patient journals. Results: Ninety-seven PMR patients in the historical cohort and 113 FTC patients, of whom 83 patients had PMR, were included. The median (interquartile range) number of days from symptom onset until PMR diagnosis were 53 (31–83) days in the FTC versus 80 (58–132) days in the historical cohort (P < 0.001). Prednisolone was prescribed before rheumatological assessment to 11% in the FTC versus 42% in the historical cohort (P < 0.001). Patients in the FTC had significantly fewer contacts with the hospital before the diagnosis compared with the historical cohort. Four patients in the FTC were diagnosed with a cancer, all of which were found by imaging. Conclusion: The FTC reduced the time from symptom onset until diagnosis, lowered prednisolone initiation before rheumatological assessment, and resulted in fewer hospital visits. The frequency of cancers was low in patients suspected of PMR and cancers were discovered by imaging.
AB - Objectives: To evaluate the efficacy of a fast track clinic (FTC) for patients suspected of polymyalgia rheumatica (PMR) regarding symptom duration, prednisolone initiation before rheumatological assessment, number of hospital contacts before diagnosis, and cancer diagnosis. Methods: It is a retrospective cohort study with a one year follow-up period. Patients referred to the FTC (1st August 2016 to 25th June 2019) were compared to a historical cohort of PMR patients (1st August 2014 to 1st August 2016). Referral criteria are: age over 50, symptoms of PMR but not cranial GCA, and increased C-reactive protein. Data were obtained from patient journals. Results: Ninety-seven PMR patients in the historical cohort and 113 FTC patients, of whom 83 patients had PMR, were included. The median (interquartile range) number of days from symptom onset until PMR diagnosis were 53 (31–83) days in the FTC versus 80 (58–132) days in the historical cohort (P < 0.001). Prednisolone was prescribed before rheumatological assessment to 11% in the FTC versus 42% in the historical cohort (P < 0.001). Patients in the FTC had significantly fewer contacts with the hospital before the diagnosis compared with the historical cohort. Four patients in the FTC were diagnosed with a cancer, all of which were found by imaging. Conclusion: The FTC reduced the time from symptom onset until diagnosis, lowered prednisolone initiation before rheumatological assessment, and resulted in fewer hospital visits. The frequency of cancers was low in patients suspected of PMR and cancers were discovered by imaging.
KW - Early Detection of Cancer
KW - Giant Cell Arteritis
KW - Humans
KW - Polymyalgia Rheumatica/diagnosis
KW - Prednisolone/therapeutic use
KW - Retrospective Studies
UR - http://www.scopus.com/inward/record.url?scp=85105257802&partnerID=8YFLogxK
U2 - 10.1016/j.jbspin.2021.105185
DO - 10.1016/j.jbspin.2021.105185
M3 - Journal article
C2 - 33887471
SN - 1297-319X
VL - 88
JO - Joint Bone Spine
JF - Joint Bone Spine
IS - 5
M1 - 105185
ER -