Abstract

GPs spend a major part of their time dealing with patients with musculoskeletal symptoms. The attainment of the goal of early recognition and treatment of rheumatoid arthritis (RA) therefore depends for an important part on the skills of the GP to single out those patients with arthralgia that are at high risk for RA or already have RA. The options for the GP are history taking, clinical examination, order autoantibody tests or imaging, and referral to the rheumatologist.

GPs are not good at recognizing synovitis. Over the years, autoantibody testing has increased and time to referral has decreased. However, GP behaviour is largely unknown and varies widely across Europe, partly due to differences in health care organization and availability of GPs - and rheumatologists.

The GP needs to be supported in the decision to further test or to refer a patient with arthralgia, e.g. by defining what is clinically suspect arthralgia, a currently ongoing EULAR project. Also, a prediction rule for arthritis in patients at risk is available, but this involves patients who have already tested positive on rheumatoid factor or ACPA. In this prediction rule, symptoms play an important role. Therefore such symptoms are now being further explored by the development of the quantitative “Symptoms in Persons At Risk of Rheumatoid Arthritis (SPARRA) Questionnaire”, another EULAR project.

Finally, the experience of the RA patient in primary care during the years before diagnosis in the Netherlands is currently being analyzed. Preliminary results show an increased number of visits to primary care during these years, in particular for musculoskeletal symptoms and infections.

In conclusion, several efforts are underway to better characterize the at risk phase of RA, which will help GPs to select patients at high risk for monitoring or referral.