Poster Presentations

Abstract

Background: The workload at rheumatology clinics have been growing relentlessly and an audit on new referrals helps to identify referral behavior of primary care doctors and improvement can be done by providing further training. Objective: To audit on new referral cases to rheumatology clinic during Covid-19 pandemic 2020 and to identify new cases with misdiagnosis for future training purpose. Methods: This was a retrospective study. The electronic medical records of all new referral to rheumatology clinic Hospital Sultan Ismail from 1 st January 2020 to 28 th February 2021 were reviewed. The variety of new cases, reason of referral and final diagnoses were identified and analyzed. Results: There were total of 462 new cases referred throughout the 14 months during Covid-19 pandemic. Majority of them are diagnosed to have rheumatoid arthritis (RA, 115/462) followed by systemic lupus erythematosus (SLE, 93/462), psoriatic arthritis (PSA,82/462), gout (26/462), osteoarthritis (23/462), soft tissue rheumatism (14/462), systemic sclerosis (SSc, 11/462), fibromyalgia (8/462), ankylosing spondylitis (AS, 8/462), sjogren syndrome (8/462), vasculitis (7/462), mixed connective tissue disease (MCTD, 7/462) and miscellaneous (23/462). 17 out of the new cases were diagnosed as unlikely rheumatic diseases. There were 20 pending cases awaiting final diagnosis. 96 of the referrals were identified as misdiagnosis with the highest as nodal osteoarthritis (18/96) followed by unlikely rheumatic disease (17/96), soft tissue rheumatism (14/96), RA (12/96), PSA (9/96), gout (4/96), sjogren syndrome (4/96), fibromyalgia (3/96), SLE (3/96), polymyositis (2/96), AS (2/96) and others (8/96 : DISH, hypermobility syndrome, RS3PE syndrome, degenerative disc disease, idiopathic uveitis, graft versus host disease, JIA, MCTD and traumatic arthritis). Conclusion: Nodal osteoarthritis and soft tissue rheumatism can be great mimicker for inflammatory arthritis and if wrongly diagnosed will induce unnessary anxiety or wrong treatment. More training are needed to improve clinical skills amongst primary care doctors.