Abstract
It has been suggested that rheumatological disorders are underdiagnosed in patients with medical problems and that this might be rectified by incorporating a standard brief screening examination as part of the routine assessment of all patients admitted to hospital with medical conditions. Therefore the GALS screening examination was used to assess the prevalence of rheumatic disease in 100 patients admitted with acute medical problems and in a further 100 in the rehabilitative phase of their disease. The nature of locomotor dysfunction in all patients with a positive result was defined by an independent review and then sensitivity and specificity of the screening test was calculated for rheumatic disease in both populations. The median age of the two populations were 63 and 78 years respectively, with more females in the rehabilitation group. The overall prevalence of a positive screening test was 53% in the acute and 94% in the chronic disease groups, although the false positive rate in the rehabilitation patients was 30% due to factors other than rheumatic disorders limiting locomotor function (mainly orthopaedic and neurological conditions). The diagnosis of a rheumatological disorder was made de novo in a significant minority (10%) of patients and was usually amenable to treatment. The commonest rheumatic disorder was osteoarthritis which accounted for 55% of all rheumatic disease, followed by inflammatory joint disease (16%), and osteoporosis (12%). In addition to osteoporosis, Paget's disease of bone and polymyalgia rheumatica were found more frequently in those patients undergoing rehabilitation than in those admitted with an acute medical problem. A number of clinically important associations between medical and rheumatic disorders were found, such as stroke disease with shoulder capsulitis and heart failure with gout. The sensitivity of the GALS screening test was extremely high (92% and 100%), while its specificity fell in the rehabilitation group from 83% to 17%. None the less, it is felt that this study indicates that the routine use of this test should be considered as part of the assessment of all hospitalised patients with medical problems, whether acute or chronic. Keywords: rheumatic disease; general internal medicine; GALS screening test
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- Doherty M., Abawi J., Pattrick M. Audit of medical inpatient examination: a cry from the joint. J R Coll Physicians Lond. 1990 Apr;24(2):115–118. [PMC free article] [PubMed] [Google Scholar]
- Doherty M., Dacre J., Dieppe P., Snaith M. The 'GALS' locomotor screen. Ann Rheum Dis. 1992 Oct;51(10):1165–1169. doi: 10.1136/ard.51.10.1165. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Doherty M., Dawes P. Guidelines on undergraduate curriculum in the UK. Education Committees of Arthritis and Rheumatism Council and British Society for Rheumatology. Br J Rheumatol. 1992 Jun;31(6):409–412. doi: 10.1093/rheumatology/31.6.409. [DOI] [PubMed] [Google Scholar]
- Fox R. A., Dacre J. E., Clark C. L., Scotland A. D. Impact on medical students of incorporating GALS screen teaching into the medical school curriculum. Ann Rheum Dis. 2000 Sep;59(9):668–671. doi: 10.1136/ard.59.9.668. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Haugeberg G., Uhlig T., Falch J. A., Halse J. I., Kvien T. K. Bone mineral density and frequency of osteoporosis in female patients with rheumatoid arthritis: results from 394 patients in the Oslo County Rheumatoid Arthritis register. Arthritis Rheum. 2000 Mar;43(3):522–530. doi: 10.1002/1529-0131(200003)43:3<522::AID-ANR7>3.0.CO;2-Y. [DOI] [PubMed] [Google Scholar]
- Jones A., Ledingham J., Regan M., Doherty M. A proposed minimal rheumatological screening history and examination. The joint answers back. J R Coll Physicians Lond. 1991 Apr;25(2):111–115. [PMC free article] [PubMed] [Google Scholar]
- Plant M. J., Linton S., Dodd E., Jones P. W., Dawes P. T. The GALS locomotor screen and disability. Ann Rheum Dis. 1993 Dec;52(12):886–890. doi: 10.1136/ard.52.12.886. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Spencer M. A., Dixon A. S. Rheumatological features of patients admitted as emergencies to acute general medical wards. Rheumatol Rehabil. 1981 May;20(2):71–73. doi: 10.1093/rheumatology/20.2.71. [DOI] [PubMed] [Google Scholar]
- Wright V. The epidemiology of disability. J R Coll Physicians Lond. 1982 Jul;16(3):178-9, 182-3. [PMC free article] [PubMed] [Google Scholar]
- van Jaarsveld C. H., Jacobs J. W., van der Veen M. J., Blaauw A. A., Kruize A. A., Hofman D. M., Brus H. L., van Albada-Kuipers G. A., Heurkens A. H., ter Borg E. J. Aggressive treatment in early rheumatoid arthritis: a randomised controlled trial. On behalf of the Rheumatic Research Foundation Utrecht, The Netherlands. Ann Rheum Dis. 2000 Jun;59(6):468–477. doi: 10.1136/ard.59.6.468. [DOI] [PMC free article] [PubMed] [Google Scholar]