1. What features of inflammatory arthritis aid a rheumatology nurse specialist in diagnosing inflammatory arthritis? G. Gormley 1*, K. Steele 1, D. Gilliland 1, M. Stevenson 2, E. Wylie 3, R Milligan 3, C. Matthews 3, G. Meenagh 3, A. Bell 3, A.J. Taggart 3, G. Wright 3, R Mc Kane 4, D. O’Reilly 5. Departments of General Practice 1 and Epidemiology 2, Queen’s University of Belfast; Departments of Rheumatology, Belfast City 3 and Ulster 4 Hospitals, Belfast; Health and Social Care Research Unit 5, Belfast, N.Ireland. BACKGROUND Over the last decade nursing in the UK has undergone major changes especially in the expansion of its role and responsibilities with the introduction of nurse specialists. In rheumatology the role of the specialist nurse has evolved to include drug monitoring and supervision of day to day management of rheumatic diseases. The assessment, diagnosis and management of inflammatory arthritis (IA) has changed and over recent years. There has been increasing evidence to support that early diagnosis and treatment of IA - improves long-term outcomes. However the diagnosis of IA is often difficult and confusing; the emerging role of Rheumatology nurse specialists (RNS) could assist in the early identification of patients with IA. OBJECTIVES To determine what clinical features aid RNS in diagnosing IA. METHOD Selection criteria: - From March 2000 – March 2001 patients who had been referred by their own family practitioner with a possible diagnosis of IA, to one of three Early arthritis clinics, were recruited to the study. Power calculation indicated that 96 patients would be required to detect a difference in the triage with 90% power at the 5% significance level. Assessment: - Each patient was independently assessed by one of 2 RNS, who all received a 3 session training course in the diagnosis of IA. Each RNS recorded, on a set protocol, what clinical features that they had detected from their assessment. Finally the patients were assessed by one of 6 hospital rheumatologists (HR), who had been assessed in a previous study to have a high level of diagnostic agreement 1. Each assessor determined weather the patient had a diagnosis of IA according to their clinical features. RESULTS All of the 96 patients invited, consented to participate. 49(51.0%) patients referred were deemed appropriate referrals by the assessing HR. 43(87.8%) out of these 49 patients were identified by the RNS as being appropriate referrals. The level of agreement between the RNS and HR in making a diagnosis of IA was calculated using the kappa statistic, where a value of 1 represents total agreement. The kappa value between the RNS and HR was 0.79 which compares favourably with similar studies in other specialities such as radiology and ophthalmology 2. Of the 43 patients correctly identified by the RNS as having IA, the clinical features likely to predict a positive diagnosis were the symptom of joint stiffness (exp (B) 5.007) and the sign of joint swelling (exp (B) 16.426). If the patient was found to have the symptom of joint stiffness >30mins in the morning or after rest, that this increased the likelihood of that patient having IA by 5 fold. If the patients was found to have the sign of joint swelling, that this increased the likelihood of that patient having IA by 16 fold. CONCLUSION These results demonstrate that if a patient presents with swelling and joint stiffness the RNS was likely to correctly diagnosis IA. These results have implications for the development of diagnostic guidelines and in the training/education of rheumatology specialist nurses and triage of patients referred to rheumatology services. REFERENCES 1).Gormley et al. Can rheumatologists agree on a diagnosis of inflammatory arthritis in an early synovitis clinic? Annals of rheumatic diseases 2001; 60(6): 638-639 2).Sackett D L et al. Clinical epidemiology-a basic science for clinical medicine. London: Little, Brown, 1991: 19-49