042 Challenges Faced in Primary Care During the Early Stages of Rheumatoid Arthritis: A Cross-Sectional Survey of General Practitioners

Mangat, Navjeet S.; Raza, Karim; Clarkson, Kris; Stack, Rebecca; Mallen, Christian; Belcher, John; Hider, Samantha

Abstract

Background: Early treatment can reduce morbidity and mortality in patients with RA. However, identifying early RA can be challenging, in part because many of its initial symptoms are non-specific. Delays in recognising RA and referral to secondary care can lead to delays in treatment initiation. This study aimed to investigate general practitioner (GP) confidence in diagnosing RA and potential challenges in diagnosing RA.

Methods: A cross-sectional questionnaire survey was conducted across 5000 English GPs. GPs were asked to rate their confidence in diagnosing RA and in assessing synovitis [visual analogue scale (VAS) 1–10] and their level of agreement with 10 statements about diagnosing RA, e.g. RA is easy to recognize and diagnose (reverse VAS 1–5, i.e. 1 = strongly agree, 5 = strongly disagree). Data were analysed using nominal regression. Ethical approval for the study was obtained from Keele University, Staffordshire, UK.

Results: A total of 1388 (27.8%) GPs completed the questionnaire. The mean age was 47.0 years (S.D. 9.4), 705 (51%) were female and 1052 (76.3%) were GP partners. The average experience as a GP was 16.6 years (S.D. 9.7). Overall, GPs were moderately confident in the diagnosis of RA {median 7/10 [interquartile range (IQR) 5–7]} and the assessment of synovitis [median 7 (IQR 6–8)]. There was a strong correlation between being confident in diagnosing RA and being confident in assessing synovitis (Spearman’s ρ = 0.609, P < 0.01).

GPs who were more confident in diagnosing early RA were more likely to be confident in assessing synovitis {nominal regression [odds ratio (OR) 2.05, P < 0.001]}. Those confident in assessing for synovitis disagreed that examination yielded little information towards clinical decision-making (OR 1.35, P = 0.002). Agreeing that early RA is difficult to recognize was associated with a greater likelihood of having a watch and wait approach to aid decision-making (OR 1.53, P < 0.001). They also felt it was difficult to distinguish RA from other potential diagnoses (OR 1.26, P = 0.032) and that the symptoms characterising early RA were poorly defined (OR 1.66, P < 0.001). There was a small but significant inverse association between rating early RA as difficult to recognize and the age of the GP (OR 0.97, P = 0.001).

Conclusion: There is an association between confidence in assessing synovitis and the use of examination in assessing for early RA. GPs who use examination to aid decision-making are more likely to have a more comprehensive approach, i.e. using history, family history, and blood tests as well. Meanwhile, finding RA difficult to recognize is associated a more watch and wait approach. This could be a potential source of delay in treatment.

Citation

Mangat, N. S., Raza, K., Clarkson, K., Stack, R., Mallen, C., Belcher, J., & Hider, S. 042 Challenges Faced in Primary Care During the Early Stages of Rheumatoid Arthritis: A Cross-Sectional Survey of General Practitioners. Poster presented at Rheumatology 2016

• Presentation Conference Type: Poster
• Conference Name: Rheumatology 2016
• Deposit Date: Aug 25, 2023
• Publisher: Oxford University Press
• DOI: https://doi.org/10.1093/rheumatology/kew140.005
• Publisher URL: https://academic.oup.com/rheumatology/article/55/suppl_1/i78/1794649