AB1361-HPR PRIMARY CARE PHARMACOLOGICAL TREATMENT FOR PATIENTS WITH HAND ARTHRALGIA

Abstract

Background:Primary care physicians (PCP) are the first point of contact for patients with a new-onset inflammatory rheumatic disease, like rheumatoid arthritis (RA). Consequently, primary care is crucial to the early diagnosis and prompt treatment of such individuals. The first three months following the onset of RA symptoms represent an important therapeutic window. Historically, patients with inflammatory arthritis received first-line treatment with non-steroidal anti-inflammatory drugs (NSAIDs), moving to synthetic disease-modifying anti-rheumatic drugs (DMARDs) relatively late in the disease process. As synthetic DMARDs are usually initiated in secondary care by rheumatologists, PCP focus on alleviation of patient’s discomfort. Documented problems in primary care practice include accuracy of diagnosis, test ordering, medication use and delays in referral.There is no evidence of which is the pharmacological treatment more commonly used for hand arthralgia in Family Medicine patients of a university hospital on their first or second visit.Objectives:To examine the primary care physicians’ pharmacological treatment prescribed for hand arthralgia in a Family Medicine Consultation.Methods:In a period of a year and two months, eligible patients were recruited on their first or second visit to the Family Medicine Consultation of the Hospital Universitario “Dr. José Eleuterio González” in Monterrey, Nuevo León, México. Eligible patients were adults (aged≥18 years) with hand arthralgia as their chief complaint, who had not rheumatologic diagnosis and wasn’t caused by trauma. Ninety patients were recruited, data were collected by capturing the prescription made by PCP.Results:In this cohort of 90 patients, 71 (78.9%) were women. Of the 90 patients, 19 (21.1%) had no pharmacological prescription at all. Forty-nine patients (54.4%) had one prescribed drug, 17 (18.9%) had two drugs and 5 (5.6%) had three drugs. Prescribed drugs and their frequencies are reported in Table 1.Table 1.Prescribed drugs and frequencies.Drugn (%)No treatment19 (21.1)Celecoxib26 (28.9)Oxicams22 (24.4)Propionic acid derivatives6 (6.7)Phenyl Acetic acids5 (5.6)Acetaminophen15 (16.7)Tramadol12 (13.3)Steroids11 (12.2)Methotrexate1 (1.1)Conclusion:The most common group of drugs used for hand arthralgia in this cohort of patients was NSAID, and the most used of this group was celecoxib. Only in one patient, PCP prescribed disease-modifying anti-rheumatic drugs (DMARD) therapy, in this case was methotrexate. Almost 80% of the patients were prescribed with at least one drug without knowing the final diagnosis.References:[1]Warburton L, Hider SL, Mallen CD, Scott IC. Suspected very early inflammatory rheumatic diseases in primary care. Best Pract Res Clin Rheumatol. 2019;33(4):101419[2]Calabrese L. Rheumatoid arthritis and primary care: The case for early diagnosis and treatment. The Journal of the American Osteopathic Association. 1999;99(6):313.Disclosure of Interests:None declared