Management of rheumatoid arthritis in primary care(I)

The Family Doctor’s role in diagnosis and monitoring of patients having rheumatoid arthritis (RA) is not very well established in Romania. RA, a chronic, inflammatory disease, with a progressive evolution, systemic symptoms and severe disfunctions, leads to affections of the quality of life, early retiring and the decrease of life hope with 5 to 10 years. Establishing PRE-RA (Personalized Risk Estimator for Rheumatoid Arthritis)for first degree relatives of the RA affected patients, according to age, gender, family history and risk behavior, allows the preventing of the delay of the disease occurring. Some preventing measures are the following: giving up smoking, Mediterranean diet, weigh control, statins therapy in order to decrease the cardiovascular risk, the oral hygiene. RA begin with a prolonged asymptomatic period, characterized by the presence of asymptomatic small airway disease, certain infections and inflammatory disease (gut, periodontium, genitourinary tract) or dysbiosis. We can find increased circulating disease specific autoantibodies or increased in levels of cytokines and chemokines. A good knowledge of the first symptoms is very important for the family doctor and could help to recommend to the rheumatologist to start the treatment immediately after the disease occurring. The family doctor could have a very important role together with the rheumatologist and the hole team in the surveying of the disease evolution, and also of the associated comorbidities, complications and possible opposite reactions to the treatment. The family doctor is also involved in the patients’ and their families’ counselling, as the best communicates with the patients and his presence in the multidisciplinary teams increases the adherence, compliance and persistence to the therapy.