THE VALUE OF SCREENING FOR PSYCHIATRIC-DISORDERS IN RHEUMATOLOGY REFERRALS

Background: Musculoskeletal complaints are common and often unexplaine d and often lead to rheumatology referrals. The prevalence of psychiat ric disease in patients with musculoskeletal complaints is unknown. Ob jectives: To determine the prevalence of common psychiatric disorders among patients referred to a rheumatology clinic and the likelihood of establishing a rheumatic diagnosis if a psychiatric disorder is prese nt. Design: Prospective diagnostic survey. Setting: Two hospital-based rheumatology clinics and a general medicine clinic. Participants: A c onsecutive sample of newly referred patients (n = 185) and their rheum atologists (n = 9). Intervention: Before their visit, all patients fil led out a self-administered version of PRIME-MD (Primary Care Evaluati on of Mental Disorders), a questionnaire that makes Diagnostic and Sta tistical Manual of Mental Disorders, Fourth Edition: Primary Cave Vers ion, diagnoses of depressive, anxiety, and somatoform disorders. After the visit, the study rheumatologists, who were unaware of the PRIME-M D results, completed a questionnaire regarding their diagnostic assess ment. These patients were compared with 210 patients with musculoskele tal complaints who were cared for in a general medicine clinic. Main O utcome Measures: Psychiatric and rheumatic disorders. Results: Compare d with patients with musculoskeletal complaints in a general medicine clinic, patients referred to a rheumatology clinic had a higher preval ence of psychiatric disease (40% vs 29%; P = .008), had an almost 2-fo ld higher prevalence of anxiety disorders, and were more likely to hav e multiple psychiatric disorders (odds ratio = 2.70, 95% confidence in terval = 1.50-5.00). The likelihood of a psychiatric disorder differed among patients with connective tissue disease, nonsystemic articular or periarticular disorders, and nonarticular disorders (27%, 38%, 55%, respectively; P = .006). In a best-fitting logistic regression model, psychiatric disorders markedly decreased the likelihood of a connecti ve tissue disease (odds ratio = 0.24, 95% confidence interval = 0.09-0 .62). Conclusions: Forty percent of patients referred to a rheumatolog y clinic in this study had a psychiatric disorder, and its presence pr edicted a lower likelihood of a connective tissue disease. Prospective studies are needed to determine if screening for psychiatric disease before referring patients with unexplained musculoskeletal complaints would reduce costs or improve recognition of potentially treatable psy chiatric disorders.