LAUSR

Clinically Suspect Arthralgia (CSA) was defined by European League Against Rheumatism to identify a combination of clinical features that best characterise patients with arthralgia who are at risk of progression to rheumatoid arthritis (RA) (1). A specificity >90% is obtained with the presence of ≥4 parameters. Another clinical feature useful to identify patients at risk is the squeeze test (ST). Recently, we have identified the necessary strength to screen the patient with arthralgia through ST, with a median squeeze force of 3 kg and 2.78 kg to evoke pain in the right and left hand of the RA patient, respectively (2). Primary care physicians (PCP), the first contact of patients at risk, could benefit from these screening tools, prompting early referral, diagnosis, and treatment of these individuals.To identify the clinical utility of CSA and ST in the referral of patients with hand arthralgia from PCP to rheumatologists.We conducted a cohort study from October 2018 to December 2020 in 110 patients who attended a Family Medicine clinic at University Hospital “Dr. Jose Eleuterio Gonzalez” in Monterrey, Mexico. We recruited patients with hand arthralgia with no history of previous trauma or autoimmune rheumatic diseases. A questionnaire assessing CSA criteria was employed, and an ST maneuver was performed through an automated compressor with quantitative measures of applied force. Patients were grouped based on referral to Rheumatology consultation and variables categorized according to clinically relevant thresholds. Chi square test was performed in categorical variables, t-student test was performed in normal, continuous variables and Spearman’s rho correlation was utilized between CSA number of criteria and quantitative ST force using SPSS v25.Out of 110 patients, 49 (44.5%) were referred to a rheumatologist. A non-significant association was found across assessed variables in referred and non-referred patients as seen in Table 1. Spearman’s rho found a moderate correlation between the number of CSA criteria and quantitative force in right (r=-.445) and left (r=-.382) hand as seen in Figure 1. Evaluation of CSA cutoffs other than ≥4 did not yield a significant association in referral of patients to the rheumatologist (data not shown).The clinical utility of CSA criteria and ST in referral of patients with hand arthralgia from PCP to rheumatologists is currently limited. More research is needed to elucidate the clinical utility of these screening tools.[1]van Steenbergen HW, et al. EULAR definition of arthralgia suspicious for progression to rheumatoid arthritis. Ann Rheum Dis. 2017;76(3):491-496.[2]Vega-Morales D, et al. Automated squeeze test (Gaenslen’s manoeuvre) to identify patients with arthralgia suspicious for progression to RA: improving time delay to rheumatology consultation. Ann Rheum Dis. 2017;76(10):e40.Table 1.Demographic characteristics and clinical performance of CSA and ST in referral of patients with hand arthralgia from PCP to rheumatologists.Referred patients,n = 49Non-referred patients, n = 61pFemale, n (%)40 (81.6)50 (82.0)0.964Age in years, mean ± SD46.76 ± 14.4352.05 ± 15.000.064Patients with ≥4 CSA criteria, n (%)23 (46.9)19 (31.1)0.090Right hand positive ST patients, n (%)21 (42.9)22 (36.1)0.468Left hand positive ST patients, n (%)26 (53.1)28 (45.9)0.455Force in right hand ST, mean kg ± SD4.19 ± 2.923.86 ± 3.070.571Force in left hand ST, mean kg ± SD4.25 ± 3.043.54 ± 2.740.198CSA, Clinically Suspect Arthralgia; ST, Squeeze Test; SD, Standard Deviation.None declared