Challenges of diagnosing and managing polymyalgia rheumatica: a multi-methods study in UK general practice
| Autor: | Sara Muller, Christian D Mallen, Toby Helliwell, Samantha L. Hider, Sarah A Lawton, Irena Zwierska, Jane C Richardson |
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| Rok vydání: | 2017 |
| Předmět: |
musculoskeletal diseases
Adult Male medicine.medical_specialty Prednisolone education General Practice Polymyalgia rheumatica Diagnosis Differential Interviews as Topic 03 medical and health sciences 0302 clinical medicine General Practitioners medicine Humans 030212 general & internal medicine Medical diagnosis Glucocorticoids Qualitative Research 030203 arthritis & rheumatology Descriptive statistics business.industry Research Questionnaire Middle Aged medicine.disease United Kingdom Cross-Sectional Studies Telephone interview Polymyalgia Rheumatica Family medicine General practice Female Multi method Family Practice business Qualitative research |
| Zdroj: | The British journal of general practice : the journal of the Royal College of General Practitioners. 68(676) |
| ISSN: | 1478-5242 |
| Popis: | BackgroundPolymyalgia rheumatica (PMR) is one of the most common inflammatory arthritic disorders seen in older individuals. Most patients with PMR are diagnosed and managed exclusively in general practice, yet primary care-focused research is lacking.AimTo identify and explore the challenges of diagnosis and management of PMR in general practice.Design and settingA multi-methods study in UK primary care.MethodThe multi-methods study comprised two complementary studies: a national questionnaire survey of 5000 randomly selected GPs from across the UK; and a qualitative semi-structured telephone interview study of UK GPs. Simple descriptive statistics were used to analyse questionnaire data. A thematic approach was used to analyse verbatim transcripts of the GP interviews.ResultsIn total, 1249 (25%) GPs responded to the questionnaire survey. From this total, 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. Investigations advised by current British PMR guidance to attempt to rule out other causes for symptoms were not routinely requested. Concerns surrounding ongoing treatment with glucocorticoids were widespread in relation to both potential adverse effects and ongoing monitoring.ConclusionFocused strategies to investigate and therefore exclude non-PMR differential diagnoses are required for patients with new-onset suspected PMR symptoms. Additionally, ongoing active review for alternative causes for symptoms as well as vigilance for treatment complications needs to be implemented. |
| Databáze: | OpenAIRE |
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