Screening Of Gait, Arms, Leg And Spine Should Be Routine In Hospital Patients With Rheumatic Disease

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Screening Of Gait, Arms, Leg And Spine Should Be Routine In Hospital Patients

With Rheumatic Disease

A DGReview of : " What is the prevalence of rheumatic disorders in general medical

inpatients? "

Postgraduate Medical Journal

12/19/2001

By Loshak

Routine screening of gait, arms, leg and spine (GALS) should be considered as

part of the assessment of all hospitalised patients with rheumatic disease with

other medical problems, whether acute or chronic.

Rheumatologists at Queen Hospital, Gateshead, England, made this

recommendation after they found the GALS test to have extremely high (up to 100

percent) sensitivity in this group of patients.

They urged routine use of the test even though its specificity fell from 83

percent to 17 percent among patients who were in the rehabilitative phase of

their rheumatic disease.

The rheumatologists pointed out that some authorities had suggested that

rheumatological disorders were underdiagnosed in patients with medical problems.

This led them to use the GALS test to assess the prevalence of rheumatic disease

in 100 patients of median age 63 years admitted with acute medical problems and

in a further 100 patients, median age 78 years and mostly female, who were 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. Sensitivity and specificity of the screening

were calculated for rheumatic disease in both groups.

The prevalence of a positive screening test was 53 percent in the acute disease

group and 94 percent in the chronic disease group. The false positive rate in

the rehabilitation patients was 30 percent 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 10 percent of

patients and was usually amenable to treatment.

Osteoarthritis was the most common rheumatic disorder, affecting 55 percent of

all rheumatic disease. Other common rheumatic conditions included inflammatory

joint disease (16 percent) and osteoporosis (12 percent).

In addition to osteoporosis, Paget's disease of bone and polymyalgia rheumatica

were more often found in patients undergoing rehabilitation than in patients

admitted with an acute medical problem.

The rheumatologists reported finding some clinically important associations

between medical and rheumatic disorders. These included stroke disease with

shoulder capsulitis and heart failure with gout.

The sensitivity of the GALS screening test was 100 percent in the rehabilitation

group and 92 percent in those with acute medical problems.

Postgraduate Medical Journal 2001;77:774-777.