Related Experiment Video
Updated: Mar 23, 2026
02:28
Author Spotlight: Self-Assessment Protocol for Predicting Psoriatic Arthritis in Psoriasis Patients
Published on: March 1, 2024
1.0K
Rheumatologist assessment in established polymyalgia rheumatica.
Elisabeth Lindrup Nielsen1, Agnete Overgaard Donskov1,2, Christoffer Søvsø Våben1,2
1Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark.
Rheumatology (Oxford, England)
|March 21, 2026
Summary
Re-referrals are common for polymyalgia rheumatica (PMR) patients, especially those discharged quickly after diagnosis. General practitioners (GPs) often face diagnostic uncertainty, leading to revised PMR diagnoses in about a third of cases.
Area of Science:
- Rheumatology
- Internal Medicine
- Clinical Diagnostics
Background:
- Polymyalgia rheumatica (PMR) diagnosis is often managed by general practitioners (GPs) with subsequent referrals to rheumatologists.
- Understanding referral patterns and diagnostic outcomes is crucial for optimizing patient care and resource allocation.
Purpose of the Study:
- To investigate the frequency, indications, and diagnostic outcomes of patients with established PMR referred to a rheumatology clinic.
- To compare referral patterns and diagnostic outcomes between patients initially diagnosed by GPs versus rheumatologists.
Main Methods:
- A single-center retrospective cohort study of patients with established PMR referred to a rheumatology department between 2018 and 2024.
- Data collection included referral details, diagnosis, discharge, re-referral, and assessment outcomes.
- Symptoms and clinical findings were documented for analysis.
Main Results:
- Among patients diagnosed by rheumatologists, 26% of discharged individuals were re-referred, often with shorter times from diagnosis to discharge.
- Referrals from GPs were more frequently due to diagnostic uncertainty (51%) compared to rheumatologist referrals (14%).
- The PMR diagnosis was confirmed less often in patients initially diagnosed by GPs (62%) versus rheumatologists (83%).
Conclusions:
- Re-referral is a frequent occurrence in established PMR cases, with higher risk associated with early discharge.
- A significant proportion of PMR diagnoses made by GPs (one-third) were revised upon rheumatologist assessment, indicating diagnostic challenges.
- These findings support the referral of patients with suspected PMR to specialists for accurate diagnosis and management.
More Related Videos
Related Concept Videos
01:22Rheumatic Heart Disease II: Clinical Manifestations and Diagnostic Studies
970
The key clinical manifestations of Rheumatic heart disease (RHD) include several distinct cardiac symptoms.Carditis, a hallmark of acute rheumatic fever, involves inflammation of the heart's endocardium, myocardium, and pericardium. Chronic RHD often results from recurrent episodes of carditis. Its symptoms include the following:Murmurs are caused by valvular damage, especially to the mitral and aortic valves. Mitral stenosis or regurgitation is common, with characteristic heart murmurs...
970
01:20Rheumatic Heart Disease IV: Nursing Management
441
AssessmentA comprehensive assessment is essential in managing a patient with rheumatic heart disease (RHD). Begin with obtaining a detailed medical history, including recent streptococcal infections, a history of rheumatic fever, or previously diagnosed rheumatic heart disease. Assess the patient for symptoms such as fever, chest pain, widespread joint pain (arthralgia), tachycardia, pericardial friction rub, muffled heart sounds, heart murmurs, peripheral edema, subcutaneous nodules, and...
441
01:21Rheumatic Heart Disease III: Medical Management
483
Rheumatic heart disease (RHD) management can be divided into two main strategies: prevention and long-term management.Primary PreventionPrimary prevention focuses on timely diagnosis and management of group A streptococcal pharyngitis to prevent acute rheumatic fever. The most widely used antibiotic for treating this condition is intramuscular benzathine penicillin G.Acute Rheumatic Fever TreatmentThe primary treatment goal for a patient diagnosed with acute rheumatic fever is to suppress the...
483
01:23Rheumatic Heart Disease I: Introduction
821
Rheumatic heart disease or RHD is a chronic condition that results from rheumatic fever, causing permanent damage to the heart valves.Etiology and Risk FactorsIt primarily arises from rheumatic fever, an inflammatory disease that can develop after untreated or inadequately treated group A streptococcal (GAS) pharyngitis. Streptococcus spreads through direct contact with oral or respiratory secretions. While the bacteria are the causative agents, factors like malnutrition, overcrowding, poor...
821
01:27Myocarditis II: Clinical Features and Diagnostic Tests
438
Myocarditis is an inflammation of the heart muscle. The symptoms vary widely, encompassing asymptomatic presentations to severe, acute manifestations.Clinical PresentationAsymptomatic cases: In some instances, myocarditis may be asymptomatic, with the infection resolving without intervention. These cases often go undetected unless discovered incidentally through diagnostic imaging or tests conducted for other reasons.General Early Symptoms: Early symptoms of myocarditis are non-specific and can...
438
01:19Pericarditis II: Clinical Features and Diagnostic Tests
507
Pericarditis is distinguished by inflammation of the pericardium, the fibrous sac that encases the heart. It can be acute, lasting less than six weeks, or chronic, persisting for over three months. Understanding its clinical manifestations and diagnostic findings is crucial for timely and effective management.Clinical ManifestationsWhile pericarditis can be asymptomatic, it usually presents with characteristic symptoms such as:Chest Pain: The most characteristic symptom of pericarditis is chest...
507