Identifying people at risk of rheumatoid arthritis in primary care: a qualitative study

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Abstract
Background: Identification of rheumatoid arthritis (RA) in primary care is challenging and often delayed. Anticyclic citrullinated peptide (anti-CCP) antibody testing of people presenting to primary care with new-onset musculoskeletal symptoms without synovitis could help address this; those testing positive are at increased risk of developing RA. Aim: To explore how primary care clinicians currently identify and refer patients with suspected RA, and the behaviours required to implement a prediction model for guiding targeted anti-CCP testing for non-specific musculoskeletal symptoms in primary care. Design and setting: A qualitative descriptive study in primary care in England. Method: Eight GPs and eight musculoskeletal First Contact Practitioners (physiotherapists) participated in semi-structured interviews to explore their experiences of identifying and/or referring patients with suspected RA, and their views of a implementation package for the anti-CCP prediction model. Data were analysed using framework analysis. Results: Variations in practice were evident across the pathway for identifying and/or referring patients with suspected RA, including in access to and use of the anti-CCP test. Implementing the anti-CCP prediction model would require clinicians to believe its benefits outweigh its risks, engagement of primary and secondary care teams, and incorporation of the prediction model within an easily accessible and useable clinical-decision support system. Participants’ views about implementing the anti-CCP prediction model varied but were mostly positive overall. Conclusion: Implementing a prediction model to guide targeted anti-CCP testing in primary care could be feasible. Further research is required to explore the potential benefits, risks, and costs of a pathway for identifying and/or managing people at risk of RA

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