Design of an algorithm for the diagnostic approach of patients with joint pain

Daniel G. Fernández-Ávila, María Ximena Rojas, Sergio A. Mora, Paola Varela Rojas, Lucía Vanegas-García, Ana María Sapag-Durán, Andrés Alberto Hormaza, Andres Ricardo Fernández, Antonio Cachafeiro-Vilar, Belia Lucía Meléndez, Carlo V. Caballero-Uribe, Carlos Enrique Toro-Gutiérrez, Daniel Rubén Palleiro-Rivero, Diego Alejandro Jaimes-Fernández, Dina Maria Arrieta, Fausto Álvarez, Gineth Paola Pinto-Patarroyo, Guillermo Andrés Quiceno, Guillermo Pons-Estel, Jose A. Gómez PuertaJossiell Then Báez, Juan Manuel Bello-Gualtero, Juan Martín Gutiérrez, Juan Sebastian Segura, Leandro Gabriel Ferreyra, Lilith Stange, Lina Maria Saldarriaga, Manuel Francisco Ugarte-Gil, Mario H. Cardiel, Mario Javier Moreno, Maritza Quintero, Marlon B. Porras, Nelly Colman, Nilmo Noel Chávez, Oscar Orlando Ruiz, Paul Méndez-Patarroyo, Ricardo Machado-Xavier, Tomás Caicedo, Vanessa Ocampo, Wilson Armando Bautista-Molano, Yimy F. Medina, Yurilis Josefina Fuentes-Silva, Enrique R. Soriano

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Background: Rheumatic diseases are a reason for frequent consultation with primary care doctors. Unfortunately, there is a high percentage of misdiagnosis. Objective: To design an algorithm to be used by primary care physicians to improve the diagnostic approach of the patient with joint pain, and thus improve the diagnostic capacity in four rheumatic diseases. Methods: Based on the information obtained from a literature review, we identified the main symptoms, signs, and paraclinical tests related to the diagnosis of rheumatoid arthritis, spondyloarthritis with peripheral involvement, systemic lupus erythematosus with joint involvement, and osteoarthritis. We conducted 3 consultations with a group of expert rheumatologists, using the Delphi technique, to design a diagnostic algorithm that has as a starting point “joint pain” as a common symptom for the four diseases. Results: Thirty-nine rheumatologists from 18 countries of Ibero-America participated in the Delphi exercise. In the first consultation, we presented 94 items to the experts (35 symptoms, 31 signs, and 28 paraclinical tests) candidates to be part of the algorithm; 74 items (25 symptoms, 27 signs, and 22 paraclinical tests) were chosen. In the second consultation, the decision nodes of the algorithm were chosen, and in the third, its final structure was defined. The Delphi exercise lasted 8 months; 100% of the experts participated in the three consultations. Conclusion: We present an algorithm designed through an international consensus of experts, in which Delphi methodology was used, to support primary care physicians in the clinical approach to patients with joint pain.Key Points• We developed an algorithm with the participation of rheumatologists from 18 countries of Ibero-America, which gives a global vision of the clinical context of the patient with joint pain.• We integrated four rheumatic diseases into one tool with one common symptom: joint pain. It is a novel tool, as it is the first algorithm that will support the primary care physician in the consideration of four different rheumatic diseases.• It will improve the correct diagnosis and reduce the number of paraclinical tests requested by primary care physicians, in the management of patients with joint pain. This point was verified in a recently published study in the journal Rheumatology International (reference number 31).

Original languageEnglish
Pages (from-to)1581-1591
Number of pages11
JournalClinical Rheumatology
Issue number4
StatePublished - Apr 2021


  • Algorithms
  • Arthritis
  • Lupus erythematosus
  • Osteoarthritis
  • Physicians
  • Primary care
  • Rheumatoid
  • Spondyloarthritis
  • Systemic


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