Self-Assessment Triage for Inflammatory Arthritis: A Pilot Randomized Controlled Trial

Prompt referral to a rheumatologist is essential for the prevention of joint damage in people with inflammatory arthritis (IA). We investigated whether rheumatology referrals can improve triage if additional information from two self-assessment tools, namely the tender joint count (TJC) and the Early Inflammatory Arthritis Detection Tool (EIADT), was included with the referral letter.

Newly referred patients with no history of IA were recruited from two rheumatology practices. All patients were randomly allocated within a 2 × 2 factorial design to one of the following four groups: (1) no self-assessment, (2) TJC + EIADT, (3) TJC, and (4) EIADT. Participants were blinded to group allocation. Primary outcome was urgency rating, which was either 0 to 4 weeks, 4 to 6 weeks, 6 to 12 weeks, or nonurgent (>12 weeks). For each patient, an urgency rating was assigned to each of the following: (1) referral letter, (2) referral letter plus self-assessment, and (3) clinical assessment.

Two hundred two patients were recruited and allocated across the four groups. Compared to referral letter alone, adding self-assessment to the referral letter significantly increased the number of participants marked nonurgent in the EIADT group (P < 0.05, McNemar-Bowker test), but not in any of the other groups. Also, in the EIADT group, clinical assessment did not significantly increase the number of nonurgent ratings compared to referral letter plus self-assessment (P ≥ 0.05, McNemar-Bowker test).

Including the EIADT with the referral letter may improve triage for new referrals.