Primary Care in rheumatoid arthritis

Nahid Kianmehr,Anousheh Haghighi,Shabnoor Abdullatif,Fatemeh Shirani,Ali Sobhani Firoozabadi,Ali Afrasiabi,Hamed Ansari

doi:10.22631/rr.2019.69997.1077

Abstract

BackgroundGeneral practitioners (GPs) have an important role in early diagnosis, treatment, and referring rheumatoid arthritis (RA) patients. Many patients didn’t receive rheumatologist care on appropriate time. Therefore, it seems necessary to evaluate GPs’ knowledge and attitude about RA to identify some of the barriers in the optimal care of patients with RA delivered by GPs.Methods 120 GPs who were selected through simple and non-random sampling from physicians participating in 5 educational seminars which were held in Tehran. The survey questioned their confronting with RA, experience with prescribing disease-modifying anti-rheumatic drugs (DMARDs) and referral to the rheumatologist.Results28.3% of GPs had no RA patients monthly. 35.8% declared that they visit 3-5 RA patients per month on average. 95 out of 120 (79.2%) referred RA to a rheumatologist as soon as possible. Physicians' knowledge sources about rheumatoid arthritis were mostly general medical training (87.5%). 47.5% had low and 5% lacked self-esteem in managing RA patients. 92.5% of GPs were familiar with DMARDs but 22.1% of them have been ordered them. Lack of knowledge about the side effects of DMARDs was the main reason for hesitance to prescribe them. Also, we found being older, male and more experienced GPs are more comfortable in managing RA patients.ConclusionRA care delivered by GPs was not consistent with current treatment guidelines focusing on early DMARDs therapy. GPs do not have enough information and confidence in managing patients with RA. Improving physicians’ knowledge and continued educational programs are suggested.

Highlights

Rheumatoid arthritis (RA) is the most prevalent inflammatory disease of the joints [1]
Studies show that patients with RA who are referred to a rheumatologist have a 31-times greater chance of receiving Disease-modifying antirheumatic drugs (DMARDs) than patients seen by other physicians [11, 12]
Questionnaires were distributed in five national congresses as part of the continuous medical educational program (CME), in which 550 General practitioners (GPs), 136 physicians agreed to participate in this survey, and 120 (21.8%) of them properly and fully completed the questionnaire (Figure 1)

Summary

Introduction

Rheumatoid arthritis (RA) is the most prevalent inflammatory disease of the joints [1]. One study suggested that the early diagnosis and treatment of RA are necessary to prevent joint deformity, save function, and recover quality of life [3]. Disease-modifying antirheumatic drugs (DMARDs) are the first line medications for managing RA. Other treatments include nonsteroidal anti-inflammatory drugs (NSAIDs), glucocorticoids, nutritional supplements, exercise, physiotherapy, and joint replacement surgery [6,7,8,9,10]. Studies show that patients with RA who are referred to a rheumatologist have a 31-times greater chance of receiving DMARDs than patients seen by other physicians [11, 12]. 34% of the patients in this study were visited by a rheumatologist over a 2–year period [12, 13, 14]

Objectives

Methods

Results

Conclusion