Rheumatic?—A Digital Diagnostic Decision Support Tool for Individuals Suspecting Rheumatic Diseases: A Multicenter Pilot Validation Study

Frontiers in Medicine, vol. 9, pp. 774945

Abstract

Introduction Digital diagnostic decision support tools promise to accelerate diagnosis and increase health care efficiency in rheumatology. Rheumatic? is an online tool developed by specialists in rheumatology and general medicine together with patients and patient organizations. It calculates a risk score for several rheumatic diseases. We ran a pilot study retrospectively testing Rheumatic? for its ability to differentiate symptoms from existing or emerging immune-mediated rheumatic diseases from other rheumatic and musculoskeletal complaints and disorders in patients visiting rheumatology clinics. Materials and Methods The performance of Rheumatic? was tested using in three university rheumatology centers: (A) patients at Risk for RA (Karolinska Institutet, n = 50 individuals with musculoskeletal complaints and anti-citrullinated protein antibody positivity) (B) patients with early joint swelling [dataset B (Erlangen) n = 52]. (C) Patients with early arthritis where the clinician considered it likely to be of auto-immune origin [dataset C (Leiden) n = 73]. In dataset A we tested whether Rheumatic? could predict the development of arthritis. In dataset B and C we tested whether Rheumatic? could predict the development of an immune-mediated rheumatic diseases. We examined the discriminative power of the total score with the Wilcoxon rank test and the area-under-the-receiver-operating-characteristic curve (AUC-ROC). Next, we calculated the test characteristics for these patients passing the first or second expert-based Rheumatic? scoring threshold. Results The total test scores differentiated between: (A) Individuals developing arthritis or not, median 245 vs. 163, P < 0.0001, AUC-ROC = 75.3; (B) patients with an immune-mediated arthritic disease or not median 191 vs. 107, P < 0.0001, AUC-ROC = 79.0; but less patients with an immune-mediated arthritic disease or not amongst those where the clinician already considered an immune mediated disease most likely (median 262 vs. 212, P < 0.0001, AUC-ROC = 53.6). Threshold-1 (advising to visit primary care doctor) was highly specific in dataset A and B (0.72, 0.87, and 0.23, respectively) and sensitive (0.67, 0.61, and 0.67). Threshold-2 (advising to visit rheumatologic care) was very specific in all three centers but not very sensitive: specificity of 1.0, 0.96, and 0.91, sensitivity 0.05, 0.07, 0.14 in dataset A, B, and C, respectively. Conclusion Rheumatic? is a web-based patient-centered multilingual diagnostic tool capable of differentiating immune-mediated rheumatic conditions from other musculoskeletal problems. The current scoring system needs to be further optimized.

Authors 17

1. Rachel Knevel corresponding Aachen

   Leiden University Medical Center · Newcastle University

   Affiliation as printed

   Leiden University Medical Center, Leiden, Netherlands

   Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom

2. Johannes Knitza

   Friedrich-Alexander-Universität Erlangen-Nürnberg · Universitätsklinikum Erlangen · Autonomie, Gérontologie, E-santé, Imagerie et Société · Université Grenoble Alpes

   Affiliation as printed

   Department of Internal Medicine 3, Friedrich-Alexander-Universität Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany

   Deutsches Zentrum für Immuntherapie, Friedrich-Alexander-Universität Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany

   Université Grenoble Alpe, Autonomie, Gérontologie, E-santé, Imagerie et Société, Grenoble, France

3. Aase Haj Hensvold

   Karolinska University Hospital · Karolinska Institutet

   Affiliation as printed

   Center for Rheumatology, Academic Specialist Center, Stockholm, Sweden

   Division of Rheumatology, Department of Medicine, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden

4. Alexandra Cîrciumaru

   Karolinska University Hospital · Karolinska Institutet

   Affiliation as printed

   Center for Rheumatology, Academic Specialist Center, Stockholm, Sweden

   Division of Rheumatology, Department of Medicine, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden

5. Tor Bruce
   Affiliation as printed

   Ocean Observations AB, Design Consultancy, Stockholm, Sweden

6. Tjardo Daniël Maarseveen Aachen

   Leiden University Medical Center

   Affiliation as printed

   Leiden University Medical Center, Leiden, Netherlands

7. Marc P. Maurits Aachen

   Leiden University Medical Center

   Affiliation as printed

   Leiden University Medical Center, Leiden, Netherlands

8. Liesbeth J J Beaart-van de Voorde Aachen Master Advanced Nursing Practice

   University of Applied Sciences Leiden · Leiden University Medical Center

   Affiliation as printed

   Leiden University Medical Center, Leiden, Netherlands

   Master Advanced Nursing Practice, University of Applied Sciences Leiden, Leiden, Netherlands

9. David A. Simon

   Friedrich-Alexander-Universität Erlangen-Nürnberg · Universitätsklinikum Erlangen

   Affiliation as printed

   Department of Internal Medicine 3, Friedrich-Alexander-Universität Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany

   Deutsches Zentrum für Immuntherapie, Friedrich-Alexander-Universität Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany

10. Arnd Kleyer

    Friedrich-Alexander-Universität Erlangen-Nürnberg · Universitätsklinikum Erlangen

    Affiliation as printed

    Department of Internal Medicine 3, Friedrich-Alexander-Universität Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany

    Deutsches Zentrum für Immuntherapie, Friedrich-Alexander-Universität Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany

11. Martina Johannesson

    Karolinska University Hospital · Karolinska Institutet

    Affiliation as printed

    Division of Rheumatology, Department of Medicine, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden

12. Georg Andreas Schett

    Friedrich-Alexander-Universität Erlangen-Nürnberg · Universitätsklinikum Erlangen

    Affiliation as printed

    Department of Internal Medicine 3, Friedrich-Alexander-Universität Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany

    Deutsches Zentrum für Immuntherapie, Friedrich-Alexander-Universität Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany

13. Tom W. J. Huizinga Aachen

    Leiden University Medical Center

    Affiliation as printed

    Leiden University Medical Center, Leiden, Netherlands

14. Sofia Svanteson
    Affiliation as printed

    Elsa Science AB, Digital Health Company, Stockholm, Sweden

15. Alexandra Lindfors
    Affiliation as printed

    Ocean Observations AB, Design Consultancy, Stockholm, Sweden

16. Lars Klareskog

    Karolinska University Hospital · Karolinska Institutet

    Affiliation as printed

    Division of Rheumatology, Department of Medicine, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden

17. Anca I. Catrina

    Karolinska University Hospital · Karolinska Institutet

    Affiliation as printed

    Division of Rheumatology, Department of Medicine, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden