What is the prevalence of rheumatic disorders in general medical inpatients?

It has been suggested that rheumatological disorders are underdiagnosed in patients with medical problems and that this, might be rectified by incorpo rating a standard brief screening examination as part. of the routine asses sment of all patients admitted to-hospital with medical conditions. Therefo re the,GALS screening examination was used to assess the prevalence of rheu matic disease in 100 patients admitted with. acute medical problems and in a further 100 in the rehabilitative phase of their disease. The nature of l ocomotor dysfunction in all patients with a positive result was defined by an independent review and then sensitivity and specificity of the screening test was calculated for rheumatic disease in both populations. The median age of the two populations were 63 and 78 years respectively, wi th more females in the rehabilitation group. The overall - prevalence of a positive screening test was 53% in the acute and 94% in the chronic disease groups, although the false positive rate in the rehabilitation patients wa s 30% due to factors other than rheumatic disorders limiting locomotor func tion (mainly orthopaedic and neurological conditions). The diagnosis of a r heumatological disorder was made de novo in a significant minority (10%) of patients and was usually amenable to treatment. The commonest rheumatic di sorder was osteoarthritis which accounted for 55% of all rheumatic disease, followed by inflammatory joint disease (16%), and osteoporosis (12%). In a ddition to osteoporosis, Paget's disease of bone and polymyalgia rheumatica were found more frequently in those patients undergoing rehabilitation tha n in those admitted with an acute medical problem. A number of clinically i mportant associations between medical and rheumatic disorders were found, s uch as stroke disease with shoulder capsulitis and heart failure with gout. The sensitivity of the GALS screening test was extremely high (92% and 100% ), while its specificity fell in the rehabilitation group from 83% to 17%. None the less, it is felt that this study indicates that the routine use of this test should be considered as part of the assessment of all hospitalis ed patients with medical problems, whether acute or chronic.