Polymyalgia rheumatica in primary care : an exploration of the challenges of diagnosis and management using survey and qualitative methods
Background: Polymyalgia rheumatica (PMR) is one of the most common inflammatory arthritic disorders seen in older people and is closely related to giant cell arteritis (GCA). Most PMR patients are diagnosed and managed in general practice yet primary care focused research is lacking. Methods: Three...
| Main Author: | |
|---|---|
| Published: |
Keele University
2016
|
| Subjects: | |
| Online Access: | http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.695639 |
| Summary: | Background: Polymyalgia rheumatica (PMR) is one of the most common inflammatory arthritic disorders seen in older people and is closely related to giant cell arteritis (GCA). Most PMR patients are diagnosed and managed in general practice yet primary care focused research is lacking. Methods: Three complimentary studies were undertaken to investigate PMR and GCA in primary care. 1. A systematic review investigating the diagnosis and diagnostic criteria for PMR 2. A national questionnaire survey of 5000 randomly selected general practitioners (GPs) 3. Qualitative telephone interview study of GPs. Results: No validated diagnostic criteria or combination of investigations were identified that could be used for definitive PMR diagnosis. 1249 (25%) GPs responded to the questionnaire survey. 24 GPs were interviewed for the qualitative study. Features used by GPs to identify PMR were largely in-line with current guidance. Diagnosis was found to be challenging with GPs relying heavily on response to treatment with glucocorticoids. Guideline advised investigations were not routinely requested. Concerns surrounding long term treatment with glucocorticoids were widespread in relation to both potential adverse effects and on-going monitoring. Headache was the main symptom used to identify potential patients with GCA. Other symptoms indicative of GCA were less frequently used. Significant fears relating to missing a diagnosis of GCA exist as well as frustrations in forward treatment and investigation of potential GCA patients with clear regional variations in assessment and referral pathways. Conclusion: For PMR, focused GP educational strategies are needed to promote the need to exclude relevant differential diagnoses and on-going vigilance for treatment complications. Raising awareness of the range of potential features that GCA can present with could aid and improve diagnosis. To complement this, a national standard for fast track pathways for suspected GCA patients to relevant expertise could help to improve care and outcomes for patients with GCA. |
|---|