Imaging was underused. were women with a mean standard deviation (SD) age of 55.5 18.6 years. ACPA and rheumatoid factor were ordered in 28.9% Captopril (95% confidence interval 22.6C36.2) and 41.0% (95% confidence interval 33.9C48.6) of patients, respectively. Imaging was underused. Almost half (45.7%, or 37/81) of the patients with documented Captopril symptom duration experienced a delay of at least 1 year before referral; however, ACPA utilization was not associated with the delay to treatment initiation. Conclusions: Most PCPs failed to order diagnostic assessments for RA before referring a patient with polyarthritis who eventually received a diagnosis of RA. We also observed delays in diagnosis, with half of the patients waiting 1 year from symptom onset to diagnosis. These findings suggest educational efforts for PCPs should focus on emphasizing earlier diagnostic workups, especially Captopril ACPA, in patients suspected to have RA. assessments (continuous) or Fisher exact tests (categorical), but these analyses should be considered exploratory because they were not the primary end result of the study. All of the analyses were carried out using SAS statistical software (version 9.3, SAS Institute, Cary, NC). The Captopril Baystate Medical Center institutional review table determined that this project did not constitute human subjects research. Results We recognized 173 patients with RA, referred from 141 different PCPs. The Table demonstrates baseline patient characteristics. Of the 173 patients, 75.7% were seen at the PP, and 82.7% were women with a mean standard deviation age of 55.5 18.6 years. The Physique shows laboratory assessments ordered by the referring supplier. Referring clinicians ordered ACPA in only 28.9% (95% CI 22.6C36.2) and RF in 41.0% (95% CI 33.9C48.6) of patients. Ordering of ACPAs varied nonsignificantly by presenting site (26.2% CHC vs 29.8% PP, = 0.70). Radiological imaging was documented for 32.4% (n = 56) of patients, with x-ray being the most frequent (92.9%, or 52/56) and magnetic resonance imaging a distant second (12.5%, or 7/56). Captopril Functional ability was documented in only 2.3% (n = 4) of referred patients (95% CI 0.9C6.1). Open in a separate window Fig. Assessments ordered in all RA patients (N = 173) by referring supplier. Error bars symbolize 95% confidence intervals. ACPA, anti-cyclic citrullinated peptide antibody; ANA, anti-nuclear antibody; Anti-dsDNA, anti-double-stranded DNA antibody; Anti-SSA/Ro, Sjogren syndrome type A antigen; Anti-SSB/La, Sjogren syndrome type B antigen/lupus La protein; CBC, complete blood count; CMV, cytomegalovirus; CRP, C-reactive protein; EBV, Epstein-Barr computer virus; ESR, erythrocyte sedimentation rate; LFT, liver function test; RA, rheumatoid arthritis; RF, Rabbit Polyclonal to VEGFB rheumatoid factor; UA, undifferentiated arthritis. Table. Baseline individual characteristics of patients with RA = 0.63); however, almost half (45.7%, or 37/81) of the patients with documented symptom duration experienced a gap of at least 1 year between their first symptom and referral to a rheumatologist. Conversation Because nearly all workup of rheumatologic illness begins in the primary care establishing, quality improvement efforts in the diagnosis of RA must focus on PCPs. The rates of use of ACPA and RF by PCPs in appropriate patients were previously unknown, however. This study examined their use of diagnostic tools, including ACPA, in patients with a high clinical suspicion for RA. We found that most referring PCPs failed to order diagnostic assessments such as ACPA, RF, or x-rays before referring a patient to rheumatology. Although describing diagnostic delay was not the primary end result of our study, we found that (in a small subset of patients in whom we knew the timing of symptom onset) approximately 50% patients waited 1 year to be referred to a rheumatologist, potentially missing the windows for early diagnosis and treatment.8,14,16,17 These findings suggest that failure to test (and, perhaps, failure to refer) could be one of the possible mechanisms that underlies.