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The emerging risk of overdiagnosis in rheumatoid arthritis and polymyalgia rheumatica
Elizabeth Nettleton1, Kylie Carlson2, Michael Putman2
1Rheumatology Services, Rush University Medical Center, Chicago, IL, USA.
Abstract:
Overdiagnosis occurs when patients are diagnosed with a disease that would otherwise never have affected the quality or duration of their lives. This often happens unintentionally through well-meaning screening programmes that aim to detect diseases during so-called subclinical stages. Recently, it has been suggested that patients with polymyalgia rheumatica should be screened for giant cell arteritis to identify those at higher risk of relapse or vascular complications. Screening for interstitial lung disease for patients with rheumatoid arthritis has also been recommended to identify patients who could benefit from pulmonary interventions. These potential benefits must be weighed against foreseeable harms. Such harms include the uncovering of incidental findings that necessitate additional medical follow-up, the financial costs associated with screening initiatives, the risk of overtreatment through increased immunosuppression in patients who might not have otherwise required it, and the psychosocial burden of a new diagnosis. Randomised clinical trials and prospective cohort studies of screening interventions should be conducted to establish the risks and benefits and identify patients most likely to benefit from them. This Viewpoint covers risks that overdiagnosis presents to the field of rheumatology, with focus on rheumatoid arthritis and polymyalgia rheumatica.
Insights
Overdiagnosis, or diagnosing a condition that won't impact life, is a growing concern in rheumatology. Screening for conditions like giant cell arteritis and interstitial lung disease may cause more harm than good.
Area of Science:
- Rheumatology
- Medical Diagnostics
- Patient Outcomes
Background:
- Overdiagnosis occurs when patients receive a diagnosis that will not affect their quality or duration of life.
- Screening programs aim to detect diseases at subclinical stages, but can lead to unintended consequences.
- Recent recommendations include screening polymyalgia rheumatica patients for giant cell arteritis and rheumatoid arthritis patients for interstitial lung disease.
Purpose of the Study:
- To examine the risks associated with overdiagnosis in rheumatology.
- To evaluate the potential harms versus benefits of screening interventions in rheumatology.
- To highlight the need for rigorous studies on screening efficacy and patient selection.
Main Methods:
- This viewpoint discusses the potential harms of overdiagnosis based on current literature and clinical recommendations.
- It emphasizes the need for randomized clinical trials and prospective cohort studies.
- Focus is placed on screening in rheumatoid arthritis and polymyalgia rheumatica.
Main Results:
- Potential harms of overdiagnosis include incidental findings, increased medical costs, overtreatment with immunosuppression, and psychosocial burden.
- The benefits of screening for giant cell arteritis in polymyalgia rheumatica and interstitial lung disease in rheumatoid arthritis require careful consideration against these risks.
- Current evidence is insufficient to definitively establish the risk-benefit ratio for these screening initiatives.
Conclusions:
- Overdiagnosis in rheumatology, particularly in rheumatoid arthritis and polymyalgia rheumatica, presents significant risks that must be carefully weighed against potential benefits.
- Further research, including randomized trials, is crucial to determine the true risks and benefits of screening interventions.
- Identifying specific patient subgroups who would genuinely benefit from screening is essential to mitigate the harms of overdiagnosis.
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