AB1159 HIGH PREVALENCE MUSCULOSKELETAL PATHOLOGY: A CHALLENGE FOR PRIMARY ATTENDING PHYSICIANS. WHAT DO WE RHEUMATOLOGISTS CONTRIBUTE TO?

Abstract

Background: Musculoskeletal Diseases (MSKD) represent one of the main health problems burdens worldwide. They cause a significant functional, quality of life and socioeconomic impact. Knee and lumbar osteoarthritis are the most prevalent1. MSKD can be assessed by different kind of specialists: Orthopedic and Traumatology Surgery (OTS), Rheumatology and Rehabilitation, each of them focused at one of the distinct aspects of the same disease. It is the General Practitioner (GP) consultations that usually act as a gateway to specialized care. However, this derivation is carried out in non-standardized manners that leads to an evaluation from a sometimes wrong selected specialist or sometimes overlap management between several of them2. The result is an endless waiting list in an overburden health system that cannot solve people's health issues. In 2018, only in our area, 32.894 patients with MSKD were referred from GP to the different medical consultations: OTS (65%), Rehabilitation (25%) and Rheumatology (10%). Furthermore, there are specialized consultations called “Primary Trauma” to which GP can refer which are managed indistinctly by any of the 3 specialists mentioned before. Objectives: The following study aims to assess by collecting data in one of these consultations, how these pathologies are referred to the different specialist and the role that the rheumatologist plays in its management. Methods: From January to March 2019, 300 consecutive patients' medical records from the HUVM area that were sent to “Primary Trauma” consultations and attended by a rheumatologist have been reviewed. The reason for consultation, tests and referrals requested, diagnoses reached and procedures and other therapeutic actions performed were collected. Descriptive statistics with percentages and mean are showed. Results: The average age of the patients was 51 years [7-88], 57% (170) women and 43% (130) men. The most frequent reasons for referral were knee pain (26), foot pathology (23%), low back pain (12%) and carpal tunnel syndrome (6%). 68% (204 patients) attended the consultation with some test already performed request in primary care, mostly radiographs (61%) and MRI scan (34%). After the first assessment during consultation, only 31% required new studies. The diagnoses that were most frequently established are showed in table 1: degenerative knee pathology (29%) was the most prevalent. 60% of the patients assessed were given exercise tables and/or postural recommendations. 14% received an infiltration on the same day of the visit. Only 78 patients (26%) needed to be reviewed later in those consultations. Of the remaining 222 (74%), 81 (27%) were referred to other specialists. 56 of them (19%) went to OTS to a surgical evaluation, most frequently of the knee (32%), hand (27%) and foot (23%). 141 (47%) were discharged and referred to GP's for follow ups. Conclusion: The prevalence of MSKD found in medical consultation coincides with the national registers. Most patients did not need to be referred to surgical units. The role of the Rheumatologist is to take a comprehensive care for the patient, focusing on giving an effective evaluation and quick solution to his MSKD. In short, if the most prevalent MSKD are not subsidiary of surgical treatment (at least initially), the specialist whom patients with MSKD should be referred would be the rheumatologist.