Primary Care in rheumatoid arthritis

Abstract

General practitioners (GPs) play an important role in the early diagnosis, treatment, and referral of rheumatoid arthritis (RA) patients. Many patients do not receive rheumatologist care at the appropriate time. Therefore, it seems necessary to evaluate the knowledge and attitude of GPs toward RA to identify some of the barriers in the optimal care of patients with RA delivered by GPs. A total of 120 GPs were selected through simple and non-random sampling from physicians participating in five educational seminars held in Tehran. The survey used in this study questioned their experience with RA, with prescribing disease-modifying anti-rheumatic drugs (DMARDs), and with making referrals to a rheumatologist. Among the GPs in this study, 28.3% had no RA patients monthly, 35.8% declared that they visit 3-5 RA patients per month on average, and95 out of 120 (79.2%) referred RA patients to a rheumatologist as soon as possible. The majority of physicians (87.5%) sourced their knowledge about rheumatoid arthritis mostly from their general medical training. 47.5% had low and 5% lacked self-esteem in managing RA patients. 92.5% of GPs were familiar with DMARDs, but only 22.1% of them had ordered them. Lacking knowledge about the side effects of DMARDs was the main reason for hesitance in prescribing them. The results also revealed that older, male, and more experienced GPs were more comfortable in managing RA patients. This study showed that the RA care delivered by GPs is not consistent with current treatment guidelines focusing on early DMARDs therapy. GPs do not have enough information or confidence for managing patients with RA. Improving physicians' knowledge and continued educational programs are suggested.