PDF(Pubmed)
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.
摘要：
类风湿性关节炎(RA)可导致严重的关节损伤和慢性残疾。初级保健(PC),由全科医生(GP)提供，是民众与医疗系统的第一级接触。本次范围审查的目的是分析在PC设置中RA的方法。PubMed,Scopus,从2013年到2023年，使用MESH术语“类风湿性关节炎”和“初级保健”搜索了WebofScience。搜索策略遵循PRISMA-ScR指南。选取的61篇文章在表格中进行了定性分析，分两节进行了讨论，即对PC中RA管理的批评和策略。PC中RA管理的主要关键问题如下：诊断困难和延迟，在接受风湿病治疗时，以及全科医生使用DMARDs；全科医生与专家之间的沟通无效；患者教育不佳；缺乏心血管预防；以及医疗保健成本的增加。为了克服这些批评，已经确定了几种管理策略，即RA的早期诊断，快速获得风湿病护理，全科医生和专家之间的有效沟通，积极的患者参与，筛查风险因素和合并症，临床审计,跨学科患者管理，数字健康,和成本分析。PC似乎是降低慢性病发病率和死亡率的理想医疗保健环境，包括RA,如果全科医生对疾病和患者的治疗方法发生广泛变化是强制性的。
