Community screening for rheumatic diseases in Cyprus: a university–patient–scientific partnership

Issue

In rheumatic diseases, leading causes of disability and reduced work participation, prompt detection is critical to limiting long-term burden. In Cyprus, and similar settings, limited specialist capacity and lack of structured primary care screening may contribute to delayed recognition and referral.

Description

rECORD brought together researchers, clinicians and patient representatives to adapt the EpiReumaPt screening tool for the Cypriot context through cultural adaptation and expert consensus. Three consecutive pilot studies were conducted in rural community settings: the first assessed item performance, while the second (N = 191) and third (N = 82) evaluated diagnostic accuracy. All followed a two-phase same-day process: screening by trained nursing students, followed by blinded clinical assessment by specialists for all screen-positive and 20% of screen-negative participants.

Results

The structured tool, covering symptoms and disease-specific screening pathways across major RMD categories, demonstrated feasibility and case-finding capacity with high pooled sensitivity (∼95%, 95% exact CI 89–98), supporting its role as referral tool. While improved compared with the original prototype, specificity was moderate (∼46%, 95% CI 19–75) and less precise, as a few screen-negative underwent verification. Implementation confirmed usability by trained non-specialist staff and high participation among screen-positive individuals, while also noting challenges in referral uptake among screen-negative cases.

Lessons

Community-based RMD screening can support earlier identification and referral, but its impact depends on primary care readiness and training, as well as specialist system capacity. The rECORD experience illustrates the value of partnerships in adapting evidence-based tools to local contexts. Screening could be embedded in strengthened referral pathways but primary care training and the potential for over-referral must consider available specialist capacity.

Key messages

• A culturally adapted RMD screening tool showed strong case-finding potential for use in community and primary care settings.

• Screening improves early recognition only when linked to trained primary care teams, effective referral pathways and sufficient specialist capacity.