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Updated: Apr 24, 2026
Author Spotlight: Self-Assessment Protocol for Predicting Psoriatic Arthritis in Psoriasis Patients
Published on: March 1, 2024
Comprehensive arthritis referral study -- phase 2: analysis of the comprehensive arthritis referral tool
Andrew E Thompson1, Sara L Haig2, Nicole G H LeRiche2
1From the Department of Medicine, Division of Rheumatology, Western University, London, Ontario, Canada.A.E. Thompson, BSc, MD, FRCPC, Associate Professor of Medicine; N.G.H. LeRiche, MD, Associate Professor of Medicine; G. Rohekar, MD, Assistant Professor of Medicine; S. Rohekar, MD, Assistant Professor of Medicine; J. Pope, MD, Professor of Medicine, Western University, Rheumatology Centre, St. Joseph's Hospital; S.L. Haig, MD, Resident in Internal Medicine, Western University. andy.thompson@rogers.com.
Objective:
Rheumatologists triage referrals to assess those patients who may benefit from early intervention. We describe a referral tool and formally evaluate its sensitivity for urgent and early inflammatory arthritis (EIA) referrals.
Methods:
All referrals received on a standardized referral tool were reviewed by a rheumatologist and, based on the information conferred, assigned a triage grade using a previously described triage system. Each referral was also dichotomized as suspected EIA or not. After the initial rheumatologic assessment, the diagnosis was recorded and a consultation grade, blinded to referral grade, was assigned to each case. Agreement between referral and consultation grades was assessed. A regression analysis was performed to determine factors that predicted truly urgent referrals including EIA.
Results:
We evaluated 696 referrals. A total of 210 (30.2%) were categorized as urgent at the time of consultation. The referral tool was able to successfully detect 169 of these referrals (sensitivity 80.5%, specificity 79.4%). EIA occurred in 95 (13.6%); of those referrals, 86 were correctly classified as urgent at the time of triage (sensitivity 90.5%, specificity 69.6%). Items that helped correctly discriminate urgent or EIA referrals included patient age < 60, duration of disease, morning stiffness, patient-reported joint swelling, a personal or family history of psoriasis, urgency as rated by referring physician, prior assessment by a rheumatologist, elevated C-reactive protein, and a positive rheumatoid factor.
Conclusion:
A 1-page referral tool that includes parts completed by the referring physician and patient has good sensitivity to detect urgent referrals including EIA.
