Authors (including presenting author) :
Tsang Ching Man
Affiliation :
Medicine & Geriatrics, Tuen Mun Hospital
Introduction :
Clinical remission is the main therapeutic target for all patients with RA, and low disease activity is another best possible alternative if clinical remission cannot be achieved at present moment (Smolen et al, 2020). To achieve this therapeutic target, early recognition and early diagnosis of RA are crucial to identify RA case with early intervention. Thus, Integrated Model of Specialist Outpatient Service through Medical Nurse Clinic (Rheumatology) – Rheumatoid Arthritis has been set up since 10/2018 to screen patients with possible diagnosis of RA. Under this bundle service, the rheumatology nurse provides initial assessment with comprehensive history taking, physical examination and prescribe relevant laboratory test for patient. Through this early triage of probable RA cases, the rheumatologist can prescribe conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) to patient once confirmed diagnosis in the first consultation in order to prevent or reduce structural joint damage, avoid functional impairment, and reduce mortality risk that greatly improve the management of RA (Ho et al, 2019).
The sensitivity and specificity of 2010 ACR-EULAR Classification Criteria were both 74% (Van der Linden et al., 2011). There was a Japanese study showed the sensitivity and specificity under 2010 ACR-EULAR Classification Criteria of RA were 73.5% and 71.4% respectively (Kaneko et al., 2011). Validation of the tool in nurse clinic may give an insight to further development of the service.
Objectives :
To validate the sensitivity and specificity of 2010 ACR-EULAR Classification Criteria of rheumatoid arthritis under nurse clinic in Tuen Mun Hospital.
Methodology :
The study was a retrospective cohort study. Inclusion Criteria-All candidates’ complaint with peripheral joint pain and with referral to consult rheumatologist in Tuen Mun Hospital. Exclusion Criteria-Already diagnosed rheumatic disease in private sector before attending nurse clinic are excluded. The candidates defaulted the rheumatologist’s consultation also be excluded.
Result & Outcome :
There were 328 records had been reviewed from October 2018 to October 2020 from Integrated Model of Specialist Outpatient Service through Medical Nurse Clinic (Rheumatology) – Rheumatoid Arthritis. Only 274 were fulfill inclusion criteria. The demographic data of the candidates were as follow: Ethnicity Chinese N=271 (98.9%) Non-Chinese N=3 (1.1%) Sex Female N=215 (78.5%) Male N=59 (21.5%) Age Mean=55.1 Minimum=18 Maximum=88 The sensitivity and specificity of 2010 ACR-EULAR Classification Criteria of rheumatoid arthritis under nurse clinic in Tuen Mun Hospital were 91.89% and 85.93% respectively. The difference may be due to the 2010 ACR-EULAR Classification Criteria of RA demonstrated a better performance in Chinese ethics. Larger sample size may be required to test the hypothesis in later trial.
