Newsum Elize C, de Waal Margot W M, van Steenbergen Hanna W, Gussekloo Jacobijn, van der Helm-van Mil Annette H M
Department of Rheumatology and.
Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, the Netherlands.
Rheumatology (Oxford). 2016 May;55(5):848-53. doi: 10.1093/rheumatology/kev432. Epub 2016 Jan 7.
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.
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.
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).
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.
研究全科医生（GP）在诊断近期发作的炎性关节炎过程中所使用的症状、体征及其他检查方法。在此，我们假定所记录的信息在关节炎的诊断过程中至关重要。
对一个包含16家荷兰全科诊所44350名患者电子病历的数据库进行研究。选取了2009年至2013年期间根据国际初级保健分类-1代码L88（此处总结为炎性关节炎）诊断为类风湿关节炎及相关病症的患者。对转诊患者和未转诊患者的症状、体征及所进行的其他检查的频率进行评估和比较。
共有126名患者被诊断为炎性关节炎。分别有64%、90%、80%、52%、48%和41%的患者记录了症状持续时间、症状部位、肿胀、功能丧失、发红和发热情况。分别有20%、18%和17%的患者提供了晨僵、家族史或挤压试验的信息。未记录对称性、炎性关节痛和握拳情况。分别有40% - 46%的患者进行了急性期反应物检测，8% - 11%的患者进行了自身抗体检测。84名患者（67%）被转诊至二级医疗机构。足部症状、晨僵、家族史、肌痛、无发红及急性期反应物升高与转诊相关（所有P < 0.05）。
全科医生主要使用经典的炎症体征来诊断炎性关节炎。二级医疗机构常规评估的其他项目（晨僵、挤压试验、家族史），全科医生很少记录。
