Rheumatologist assessment in established polymyalgia rheumatica.

Abstract

Patients with established polymyalgia rheumatica (PMR) are often referred from general practitioners (GPs) to rheumatologists. This single-centre cohort study examined the frequency, indications and diagnostic outcomes of patients with established PMR referred to a rheumatology outpatient clinic after initial diagnosis by GPs or rheumatologists in a hospital outpatient setting. This single-centre retrospective cohort study included patients with established PMR referred to a department of rheumatology (2018-2024). Data from patient records covered time of referral, PMR diagnosis, discharge, re-referral, and indication for and outcome of rheumatologist assessment of patients with established PMR. Symptoms and clinical findings were also documented. Among 237 patients diagnosed by rheumatologists, 52/204 (26%) of discharged patients were re-referred. They had shorter time from diagnosis to discharge than those not re-referred (median: 41 days vs 230 days, P < 0.01). Referrals of the 98 patients diagnosed by GPs were more often prompted by uncertainty about their primary diagnosis of PMR (51% vs 14%, P < 0.01), and less frequently by relapse (27% vs 50%, P < 0.01) or recurrence (11% vs 31%, P < 0.01) compared with patients diagnosed by rheumatologists. The PMR diagnosis was less frequently maintained in patients diagnosed by GPs compared with patients diagnosed by rheumatologists (62% vs 83%, P < 0.05). Re-referral was common among patients with established PMR, and the risk increased with discharge shortly after PMR diagnosis. The diagnosis was revised in one-third of patients diagnosed by GPs, highlighting diagnostic challenges and supporting referral of individuals suspected of PMR consistent with current recommendations.