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Inchingolo F, Inchingolo AM, Fatone MC, Avantario P, Del Vecchio G, Pezzolla C, Mancini A, Galante F, Palermo A, Inchingolo AD, Dipalma G. Management of Rheumatoid Arthritis in Primary Care: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:662. [PMID: 38928909 PMCID: PMC11203333 DOI: 10.3390/ijerph21060662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 05/13/2024] [Accepted: 05/16/2024] [Indexed: 06/28/2024]
Abstract
Rheumatoid arthritis (RA) can lead to severe joint impairment and chronic disability. Primary care (PC), provided by general practitioners (GPs), is the first level of contact for the population with the healthcare system. The aim of this scoping review was to analyze the approach to RA in the PC setting. PubMed, Scopus, and Web of Science were searched using the MESH terms "rheumatoid arthritis" and "primary care" from 2013 to 2023. The search strategy followed the PRISMA-ScR guidelines. The 61 articles selected were analyzed qualitatively in a table and discussed in two sections, namely criticisms and strategies for the management of RA in PC. The main critical issues in the management of RA in PC are the following: difficulty and delay in diagnosis, in accessing rheumatological care, and in using DMARDs by GPs; ineffective communication between GPs and specialists; poor patient education; lack of cardiovascular prevention; and increase in healthcare costs. To overcome these criticisms, several management strategies have been identified, namely early diagnosis of RA, quick access to rheumatology care, effective communication between GPs and specialists, active patient involvement, screening for risk factors and comorbidities, clinical audit, interdisciplinary patient management, digital health, and cost analysis. PC appears to be the ideal healthcare setting to reduce the morbidity and mortality of chronic disease, including RA, if a widespread change in GPs' approach to the disease and patients is mandatory.
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Affiliation(s)
- Francesco Inchingolo
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.M.I.); (P.A.); (G.D.V.); (C.P.); (A.M.); (A.D.I.); (G.D.)
| | - Angelo Michele Inchingolo
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.M.I.); (P.A.); (G.D.V.); (C.P.); (A.M.); (A.D.I.); (G.D.)
| | | | - Pasquale Avantario
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.M.I.); (P.A.); (G.D.V.); (C.P.); (A.M.); (A.D.I.); (G.D.)
| | - Gaetano Del Vecchio
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.M.I.); (P.A.); (G.D.V.); (C.P.); (A.M.); (A.D.I.); (G.D.)
| | - Carmela Pezzolla
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.M.I.); (P.A.); (G.D.V.); (C.P.); (A.M.); (A.D.I.); (G.D.)
| | - Antonio Mancini
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.M.I.); (P.A.); (G.D.V.); (C.P.); (A.M.); (A.D.I.); (G.D.)
| | | | - Andrea Palermo
- College of Medicine and Dentistry, Birmingham B4 6BN, UK
| | - Alessio Danilo Inchingolo
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.M.I.); (P.A.); (G.D.V.); (C.P.); (A.M.); (A.D.I.); (G.D.)
| | - Gianna Dipalma
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.M.I.); (P.A.); (G.D.V.); (C.P.); (A.M.); (A.D.I.); (G.D.)
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Hakeem OB, Abubakar Y, Courage U, Joshua OG, Olujimi S, Abdulaziz U, Uyi IE, Ojo O, Adelowo O, Olusegun OA, Nwankwo H, Ibukunoluwa D, Ibrahim D, Ahmed H, Ajibade A, Ehi A, Dungwom PS, Okwara C, Harriet E, Osuagwu N, Uchechukwu T, Egbe T, Ako I, Idowu A, Akpabio AA, Tito A, Abdulhakeem A, Ochiagha O, Janetta I. Rheumatoid arthritis knowledge gap and intervention in Nigeria study. Int J Rheum Dis 2024; 27:e14993. [PMID: 38108585 DOI: 10.1111/1756-185x.14993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 11/08/2023] [Accepted: 11/23/2023] [Indexed: 12/19/2023]
Abstract
INTRODUCTION Family physicians are often the first healthcare providers to encounter patients with rheumatoid arthritis (RA) in Nigeria, given the paucity of rheumatology services nationwide. This study aimed to assess and address the knowledge gap regarding RA among family physicians in Nigeria. METHODS A cross-sectional survey involving 609 family physicians from all six geopolitical zones of Nigeria was conducted in October 2022. Pre-intervention questionnaires were administered to assess the participants' knowledge of RA. An investigator-led PowerPoint presentation on RA was then delivered as an intervention, followed by the same participants completing post-intervention questionnaires to evaluate knowledge improvement. Data were analyzed using the Statistical Package for Social Science, version 25. RESULTS The mean age of participants was 42 ± 15 years, predominantly male (63.9%). The median pre-intervention knowledge score was 3.2 (IQR: 2.0-4.5), with 77.0% scoring <5. After the intervention, the median score significantly improved to 7.1 (IQR: 4.3-8.6) (p = .001), with 62.6% scoring >7. Significant improvements were observed in several knowledge areas where gaps existed pre-intervention, including the understanding that NSAIDs are not the mainstay of management (p < .001), the effectiveness of glucosamine and chondroitin sulfate (p < .001), confidence in diagnosing RA (p = .016), the recognition of joint deformities as a characteristic feature (p < .001), and the understanding that rheumatoid factor is not definitive for diagnosis (p < .001). CONCLUSION This study highlights the importance of interventions in closing the knowledge gap about RA diagnosis and management. We recommend the implementation of a comprehensive approach to rheumatology education and services by policymakers.
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Affiliation(s)
- Olaosebikan B Hakeem
- Department of Medicine, Rheumatology Unit, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria
| | - Yerima Abubakar
- Department of Medicine, Rheumatology Unit, University of Maiduguri Teaching Hospital, Maiduguri, Nigeria
| | - Uhunmwangho Courage
- Department of Medicine, Rheumatology Unit, University of Jos/Jos University Teaching Hospital, Jos, Nigeria
| | - Odunlami Gbenga Joshua
- Department of Medicine, Rheumatology Unit, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - Shodipo Olujimi
- Department of Family Medicine, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria
| | - Umar Abdulaziz
- Department of Medicine, Rheumatology Unit, Ahmadu Bello University Teaching Hospital, Kaduna, Nigeria
| | - Ima-Edomwonyi Uyi
- Department of Medicine, Rheumatology Unit, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Osaze Ojo
- Kubwa General Hospital, Abuja, Nigeria
| | - Olufemi Adelowo
- Department of Medicine, Rheumatology Unit, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria
| | - Oguntona A Olusegun
- Rheumatology Unit, Olabisi Onabanjo University Teaching Hospital, Shagamu, Nigeria
| | - Henry Nwankwo
- Department of Medicine, Rheumatology Unit, Nnamdi Azikwe University Teaching Hospital, Nnewi, Nigeria
| | - Dedeke Ibukunoluwa
- Department of Medicine, Rheumatology Unit, University College Hospital, Ibadan, Nigeria
| | - Daiyabu Ibrahim
- Department of Medicine, Rheumatology Unit, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Hamidu Ahmed
- Department of Medicine, Rheumatology Unit, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Adenitan Ajibade
- Department of Medicine, Rheumatology Unit, Federal Medical Centre, Gombe, Nigeria
| | - Aigbokhan Ehi
- Department of Medicine, Rheumatology Unit, University of Benin Teaching Hospital, Benin, Nigeria
| | - Pam Stephen Dungwom
- Department of Medicine, Rheumatology Unit, Jos University Teaching Hospital, Jos, Nigeria
| | - Chibuzor Okwara
- Department of Medicine, Rheumatology Unit, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Ezike Harriet
- Department of Medicine, Rheumatology Unit, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Njideka Osuagwu
- Department of Medicine, Rheumatology Unit, Federal Medical Centre, Owerri, Nigeria
| | - Tralagba Uchechukwu
- Department of Medicine, Rheumatology Unit, University of Port Harcourt, Port Harcourt, Nigeria
| | - Tamara Egbe
- Department of Medicine, Rheumatology Unit, Federal Medical Centre, Yenagoa, Nigeria
| | - Itam Ako
- Department of Medicine, Rheumatology Unit, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Alabi Idowu
- Department of Medicine, Rheumatology Unit, Ekiti State University Teaching Hospital, Ado Ekiti, Nigeria
| | - Akpabio A Akpabio
- Department of Medicine, Rheumatology Unit, University of Uyo Teaching Hospital, Uyo, Nigeria
| | - Asekhame Tito
- Department of Medicine, Rheumatology Unit, Nnamdi Azikwe Teaching Hospital, Nnewi, Nigeria
| | - Awesu Abdulhakeem
- Department of Medicine, Rheumatology Unit, Federal Medical Centre, Katsina, Nigeria
| | - Olisa Ochiagha
- Department of Medicine, Rheumatology Unit, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
| | - Ikoro Janetta
- Department of Medicine, Rheumatology Unit, Federal Medical Centre, Yenagoa, Nigeria
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