Management of Rheumatoid Arthritis in Primary Care: A Scoping Review

Area of Science:

• Rheumatology
• Primary Care Medicine
• Health Services Research

Background:

• Rheumatoid arthritis (RA) is a chronic autoimmune disease causing joint impairment and disability.
• Primary care (PC) serves as the initial point of contact for most patients within the healthcare system.
• General practitioners (GPs) in PC play a crucial role in managing chronic conditions like RA.

Purpose of the Study:

• To conduct a scoping review analyzing the current approach to rheumatoid arthritis management in primary care.
• To identify critical issues and effective strategies for RA care within the PC setting.

Main Methods:

• A comprehensive literature search was performed on PubMed, Scopus, and Web of Science for articles published between 2013 and 2023.
• Keywords used included "rheumatoid arthritis" and "primary care", adhering to PRISMA-ScR guidelines.
• Sixty-one selected articles underwent qualitative analysis, focusing on criticisms and management strategies.

Main Results:

• Key challenges in PC management of RA include diagnostic delays, difficulties accessing specialist care, and suboptimal use of disease-modifying antirheumatic drugs (DMARDs).
• Ineffective communication between GPs and specialists, poor patient education, and inadequate cardiovascular risk management were also identified.
• Identified strategies to improve RA care include early diagnosis, streamlined access to rheumatology, enhanced interprofessional communication, and patient engagement.

Conclusions:

• Primary care is a pivotal setting for reducing RA morbidity and mortality.
• A significant shift in GPs' approach to RA diagnosis, management, and patient interaction is essential for optimizing care.
• Integrating strategies like early detection, improved communication, and patient-centered approaches can enhance rheumatoid arthritis outcomes in primary care.