FRI0072 Early Detection of Inflammatory Arthritis: The Role of Musculoskeletal Symptoms, Infections and Rheumatoid Arthritis-Related Comorbidities in Primary Care

Background Rheumatoid arthritis is characterized by clinically apparent inflammatory arthritis (IA). A preclinical phase has been recognized in which symptoms arise and ambulatory care utilization increases. However, information on location and timing of symptoms before IA diagnosis is still largely lacking. Objectives The present study was undertaken to identify pathogenetic clues to the development of IA and to assist early identification of future IA patients with a focus on musculoskeletal symptoms, infections and chronic comorbidities. Methods We conducted a nested case-control study using data from electronic medical records of general practitioners, participating in NIVEL Primary Care Database, to evaluate timing and numbers of visits for symptoms linked to above mentioned groups before a diagnosis of IA. Cases were adults who received a newly diagnosis of IA between 2012 and 2014, in total 2772. Retrospective follow-up had a median of 3.4 years (range 1–9). Controls were matched 1:2 on age, gender, general practice and retrospective duration of follow-up. We studied a total of 192 different symptoms or (chronic) diseases using the International Classification of Primary Care (ICPC-1) coding system. The frequency of primary care visits between the IA patients and controls were compared using logistic regression in different time periods before date of diagnosis. To investigate which of the individual symptoms or diseases were seen often, chisquare tests (chi2) were performed to evaluate the difference in frequency of these symptoms in the IA-patients compared to the controls. Results The consultation rate for musculoskeletal symptoms was increased in IA patients within the last 1.5 years before diagnosis with odds ratios (ORs) of 1.8 (confidence interval; CI: 1.6–2.1, p-value Conclusions We found significantly increased consultation rates in general practice for musculoskeletal symptoms and infectious diseases prior to the diagnosis of IA. This diverging trend started 4–6 years before diagnosis, but becomes statistically significant around 1.5 years preceding diagnosis. IA-related comorbidities and chronic diseases also show this trend, however this did not reach significance until nearly at the IA date. Possibly, these symptoms can be used to develop methods for earlier detection of IA in general practice. Disclosure of Interest None declared