Enabling rapid differentiation of rheumatic musculoskeletal disorders in patients with rheumatic musculoskeletal complaints

Rationale:
The continuous increase in national healthcare expenses has led to the
agreement between health care providers and the Dutch government to diminish
this growth (hoofdlijnenakkoord).1 This agreement necessitates health care
providers to improve care efficiency for instance to with regards to correct
patient referrals from general practitioners (GPs) to the medical specialist.

Rheumatic and Musculoskeletal Diseases (RMDs) affect 5% of the population,
while 35% of the population experiences Rheumatic and Musculoskeletal
Complaints (RMCs).2 Timely disease identification is essential to prevent harm
for patients and society. Similarly important is the early identification of
patients with RMCs without RMDs to prevent unnecessary health care expenses.
Ideally, we would equip GPs with our (scientific) knowledge about RMDs to allow
this differentiation before referring patients to the rheumatology outpatient
clinic.

Currently, patient triage is done using the GPs referral letter and if possible
a questionnaires for the patients. Some centers are experimenting with the
hands scan to identify early synovitis. New tools are being developed. A
promising tool is JPAST (Joint Pain Assessment Scoring Tool) is a diagnostic
tool developed in Sweden and tested in Germany and England. The tool combines
self-reported clinical information, serology and genetics.3 The strength of
this tool is that it combines all our current knowledge on rheumatic disease
and aims to guide patients and GPs about the likeliness of a patient having a
RMD. Currently, the tool is not yet validated in the Netherlands. Our study
will validate JPAST in the Dutch population, compare the tool with current
triage systems and search for factors to improve the differentiation between
patients with RMDs from patients with only RMCs. We aim for the most efficient
screening method with a high accuracy.

The final tool this tool could prevent unnecessary referrals to the
rheumatology clinic and prevent delay in referrals of patients with (serious)
RMDs.

Objective:
I) Test the ability of JPAST (Joint Pain Assessment Scoring Tool) to
discriminate patients with and without rheumatic musculoskeletal diseases
(RMDs) in patients referred to the rheumatology outpatient clinic.
II) Compare the JPAST*s performance with current ongoing triage systems in the
Netherlands (HandScan4,5 and questionnaire)
III) Improve JPAST by identifying novel discriminatory factors for RMDs within
patients with RMCs through examination of long-term clinical information,
genetics, vitality and life-style.

Longitudinal observational prospective (five years) study including
retrospectively (ten years) obtained data, with two year recruitment period.

We ask participants to fill out the questionnaires, give 15ml of blood, scan
their hands and allow access to their medical records for the past ten years
and upcoming five years. Since our study requires little effort from
participants, the risk and burden of all these interventions is very low. The
amount of collected information is highly relevant to improve the research to
RMDs. Our request to access clinical information before and after patients*
first visit to our clinic is relevant since many RMDs take years to develop and
critical events likely occurred years before their first visit. Likewise, it
might take years after a patient*s first visit before their disease has fully
developed.