Suspected Rheumatism – When to Refer to a Specialist, and When Not?

german translation / full article

Gülcan Sahan-Hildebrandt, Hanna Kaduszkiewicz, Pontus Harten

Keywords: basic diagnostics family practice rheumatology

BackgroundThe number of outpatient Rheumatologists is lower than the estimated need, long waiting times for a consultation are the rule. Misassignments to Rheumatologists increase the problem. The aim of this CME-article is to achieve more safety with regard to the diagnostics and treatment of rheumatoid diseases in family practice. Advice is also given as to when a referral to a Rheumatologist makes sense – and when it doesn’t.Search MethodsPragmatic search in the AWMF guideline database as well as in Google Scholar and PubMed without language restriction under medical subject headings that match the individual questions.Main MessagesThe multiple rheumatoid diseases can be classified into three broad groups: (1) inflammatory joint diseases (polyarthritis, e.g. rheumatoid arthritis), (2) inflammatory diseases of the spine (e.g. ankylosing spondylitis) and (3) inflammatory rheumatic diseases of blood vessels (vasculitis) and connective tissue diseases. The diagnosis of inflammatory rheumatoid diseases is largely clinical, laboratory parameters are used to support the suspected diagnosis. The value of single positive laboratory findings such as rheumatoid Factor, ANA or HLA-B27 is often overestimated. With a CRP value of ≤ 10 mg/l, a rheumatoid disease is very unlikely (and a referral doesn’t make sense). Methotrexate in combination with prednisolone continues to be the basic therapy of rheumatoid arthritis. The glucocorticoid therapy of polymyalgia rheumatica should be controlled according to laboratory parameters. The differentiation of fibromyalgia from rheumatic diseases is the job of the family doctor. The education and support of the affected patients is then a central part of the therapy.ConclusionsFamily physicians can specifically refer to rheumatologists if they follow the existing diagnostic algorithms. Patients with fibromyalgia syndrome should not be referred to the rheumatologist.Keywordsfamily practice; rheumatology; basic diagnostics

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(State: 16.12.2019)

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