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Rheumatoid Arthritis in Primary Care

January 9, 2017

Sarah Dill, MD
Kevin D. Deane, MD, PhD

Article

This Special Report details the expanding role PCPs can play in serving an increasingly underserved population.

Rheumatoid arthritis (RA)-a systemic, inflammatory autoimmune disease that primarily affects the joints-leads to significant morbidity and even increased mortality.¹ One of the best ways to reduce morbidity and mortality associated with RA has emerged over the past decade-a combination of early diagnosis and institution of appropriate therapy, ideally within 6 months (or sooner) of the onset of the first symptoms.^1,2

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Rheumatologist shortfall

However, there is a growing shortfall of rheumatologists. A recent American College of Rheumatology workforce study predicted a nationwide shortage of providers by 2030,³leaving patients who have rheumatologic conditions seriously underserved.

A critical role for primary care

Management of RA by primary care physicians (PCPs) will become increasingly necessary. PCPs can play a critical role in the early diagnosis and referral of patients with RA and work with rheumatologists in comanaging established disease.

In particular, given the growing understanding that early diagnosis and treatment of RA can lead to long-term improved outcomes, PCPs can contribute by recognizing the signs and symptoms of RA early so that appropriate referrals and treatment can be implemented in a timely fashion. In addition, given the declining number of rheumatologists, primary care may play a greater role in the initiation and management of long-term therapy.

Recognition, referral, and comanagement

As such, this Special Report on Rheumatoid Arthritis in Primary Care aims to help primary care physicians recognize patients who have RA and appropriately refer them, as well as provide insight into comanagement strategies. Topics will include:

• Making a diagnosis of RA-classification criteria, history, physical exam, lab studies, imaging

• Referral and initial pharmacologic management of RA

• Common medications currently used in the treatment of RA

• RA comanagement with rheumatologists

• Future directions in RA management

First up: a rheumatoid arthritis multiple-choice pretest aimed at primary care physicians. The questions will be answered in upcoming segments of this Special Report and you will see them again, as a post-test, at the conclusion of the series.

Continue to Rheumatoid Arthritis Special Report Pretest

Question 1:

Answer and Question #2 on Next Page »

The correct answer is D. A, B, and C

Question 2.

Answer and Question #3 on Next Page »

The correct answer is B. They can identify patients earlier.

Question 3.

Answer and Question #4 on Next Page »

The correct answer is D. Distal interphalangeal (DIP)

Question 4.

Answer and Question #5 on Next Page »

The correct answer is C. Physical examination

Question 5.

Answer and Question #6 on Next Page »

The correct answer is A. True

Question 6.

Answer and Question #7 on Next Page »

The correct answer is B. Methotrexate

Question 7.

Answer and Question #8 on Next Page »

The correct answer is C. Block the action of tumor necrosis factor, a powerful driver of inflammation in the RA joint

Question 8.

Answer and Question #9 on Next Page »

The correct answer is A. Advancing therapy until a patient reaches a therapeutic goal

Question 9.

Answer and Question #10 on Next Page »

The correct answer is A. Every 3 months

Question 10.

Answer on Next Page »

The correct answer is E. A and C but not B

• Click here to go to the next installment in this Special Report, Early Diagnosis of Rheumatoid Arthritis in Primary Care

References:

1. Smolen JS, Aletaha D, McInnes IB. Rheumatoid arthritis. Lancet. 2016;388:2023-2038.

2. Espinoza F, Fabre S, Pers YM. Remission-induction therapies for early rheumatoid arthritis: evidence to date and clinical implications. Ther Adv Musculoskelet Dis. 2016;8:107-118.

3. American College of Rheumatology 2015 Workforce Study http://www.rheumatology.org/portals/0/files/ACR-Workforce-Study-2015.pdf 2015