Are online symptoms checkers useful for patients with inflammatory arthritis?

Abstract

Background: Online symptom checkers are increasingly used by patients however there is little published evidence of their effectiveness in real patients. The aim of this study was to evaluate how patients with inflammatory arthritis and inflammatory arthralgia use the internet to look for health information and to assess the advice given and diagnoses suggested by the NHS and WebMD symptom checkers in relation to the patients' actual diagnoses.

Methods: Thirty-four patients with inflammatory arthritis (rheumatoid arthritis (n = 13), psoriatic arthritis (n = 4), unclassified arthritis (n = 4)) and inflammatory arthralgia (n = 13) newly presenting to a secondary care based clinic were identified using a consecutive sampling approach. Consenting patients were asked questions about their internet use in relation to their presenting symptoms. They then completed the NHS and the WebMD symptom checkers and their answers and the outcomes were recorded.

Results: Sixteen patients had previously consulted the internet regarding their symptoms. Neither age nor gender significantly influenced internet usage. Actions advised via the NHS symptom checker were: call an ambulance (n = 11), attend A&E (n = 4), contact your GP straight away (n = 2), see your GP today (n = 6), or see your GP within 36 h (n = 11). The 5 most common differential diagnoses given by Web MD were gout (n = 28), rheumatoid arthritis (n = 24), psoriatic arthritis (n = 22), osteoarthritis (n = 18) and finger dislocation (n = 10). The most common first differential diagnosis was osteoarthritis (n = 12). Only 4 out of 21 patients with inflammatory arthritis were given a first diagnosis of rheumatoid arthritis or psoriatic arthritis.

Conclusions: Our data highlight that help seeking advice given online is often inappropriate and that the diagnoses suggested are frequently inaccurate. Recommendations to seek emergency advice may cause inappropriate healthcare utilization.

Keywords: Arthralgia; Inflammatory arthritis; Internet; Symptom checker.

Fig. 1

Responses given by patients when completing the NHS choices questionnaire and the recommendations given

Fig. 2

Frequency of affected body parts chosen by patients when using WebMD

Fig. 3

Frequency of symptoms chosen by patients when completing the WebMD symptom checker

Fig. 4

Differential diagnoses given by WebMD compared with diagnoses made in clinic according to established classification criteria. Different symbols reflect the 1st, 2nd, 3rd, 4th and 5th diagnoses given by WebMD as shown in the key within the Figure. Only diagnoses given by Web MD to more than 1 patient are shown. Twenty-seven additional diagnoses were listed once by WebMD, these are shown in the Additional file 1. RA rheumatoid arthritis, PsA psoriatic arthritis, OA osteoarthritis, ACL anterior cruciate ligament, CREST CREST syndrome (Calcinosis, Raynaud’s phenomenon, Esophageal dysmotility, Sclerodactyly, and Telangiectasia), SLE systemic lupus erythematosus