The triage value of remote symptom assessment (tele-anamnesis) in the Rheumatology Outpatient Clinic

Objective: Rheumatological diseases are inflammatory and their most common feature is that they cause pain in the musculoskeletal system. In the general population, most musculoskeletal pain is caused by mechanical reasons such as trauma, degenerative problems or overuse. Therefore, there is a wide range of differential diagnosis in patients presenting with complaints of pain in the musculoskeletal system and triage is important. Especially in primary health care services where effective triage is expected, the number of patients is increasing both in the world and in our country. Remote symptom inquiry with the support of technology can contribute positively to effective triage service. Studies on triage with electronic tools are limited in the literature. This study aims to investigate the power of "tele anamnesis" obtained using remote electronic symptom inquiry to predict the inflammatory group in patients presenting with complaints of pain in the musculoskeletal system. Material and Methods: After obtaining informed written and verbal consent, the "Remote Symptom Assessment" questionnaire was sent to patients who made an appointment for the first time at the Koç University Hospital Rheumatology Clinic between January and June 2024 via mobile phone text message (SMS). The survey software infrastructure for this system, which we call tele-anamnesis, was provided by "Pisano". After the face-to-face examination and laboratory process, the final diagnoses recorded from outpatient records were divided into two as inflammatory/non-inflammatory. The data collected from the face-to-face examination and tele-anamnesis were recorded in a computer environment and the differences in responses between the two groups were analyzed. The local ethics committee approved our study with the number 2023.178.IRB1.059 and the date 04.09.2023 Results: In our study, 107 patients were reached via SMS and data from a total of 52 patients could be analyzed. The most common diagnoses were fibromyalgia syndrome in women and spondyloarthritis in men (41%, p=0.005; 52%, p=0.004). Increase in pain with movement and presence of tingling were significantly higher in the non-inflammatory group compared to the inflammatory group (75%, 35%; p=0.014, 75%, 37.5%; p=0.021, respectively). In patients presenting with axial joint complaints and diagnosed with ankylosing spondylitis (AS), the duration of pain was statistically significantly between 6 weeks and 3 months, and the duration of pain increase was more than 6 weeks (30%, 3%; p=0.045, 70%, 28%; p=0.027, respectively). Pain reduction with movement and waking up in the morning were higher in the AS group (90%, 38%; p=0.008, 90%, 55%, p=0.064, respectively). When univariate logistic regression analysis was performed for the distinction of inflammatory and non-inflammatory diseases, increase in complaints with daily tasks (p=0.014, OR: 5.57, 95% CI: 1.29-23.97) and no decrease in complaints with movement (p=0.044, OR: 0.24, 95% CI: 0.05-1.05) were found to be statistically significant in the non-inflammatory group. Conclusion: This is the first study on tele-anamnesis in the field of rheumatology. Our patients showed significant compliance with teleanamnesis. Although the power to predict inflammatory diseases does not seem to be good enough, it seems possible to predict AS, especially in patients with low back pain. Key words: Pain, rheumatology, inflammatory diseases, triage, ankylosing spondylitis