• Anne Sofie Baymler Lundberg, EsbensenBente AppelBAhttps://orcid.org/0000-0001-5331-8221Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Center of Head and Orthopedics, Rigshospitalet, Denmark.Department of Clinical Medicine, Faculty of , Martin Bach Jensen, Ellen Margrethe Hauge, and Annette de Thurah.
• Department of Clinical Pharmacology, Aarhus University Hospital, Aarhus, Denmark.
• Scand J Prim Health Care. 2021 Jun 1; 39 (2): 222-229.

ObjectiveTo explore the perspectives of general practitioners (GPs) on facilitators and barriers in diagnosing rheumatoid arthritis (RA).DesignQualitative study based on focus group interviews, and using latent thematic analysis.SettingGeneral practices from Central Region Denmark.SubjectsEleven GPs participated in three different focus groups. Forty percent were female, the mean age was 53 years (range 37-64), and the mean since medical licensing was 16 years (range 5-23). Sixty percent of the GPs worked in an area served by a university hospital, and 40% were served by a regional hospital.Main Outcome MeasureThemes describing experiences and reflections about facilitators and barriers in diagnosing Rheumatoid Arthritis.ResultsFour themes emerged: (A) If the patient is not a textbook example, (B) The importance of maintaining the gatekeeper function, (C) Difficulties in referral of patients to the rheumatologist, and (D) Laboratory tests-can they be trusted? Barriers were identified in all themes, but facilitators only in A, C, and D. The overarching theme was Like finding a needle in a haystack.ConclusionThe GPs found several barriers for diagnosing RA (symptom awareness, GP's gatekeeper function, suboptimal collaboration with rheumatologists and limitations in laboratory tests). They identified education, more specific tests and better access to rheumatologists as possible facilitators for diagnosing RA. To facilitate earlier referral of suspected RA in general practice and strengthen mutual information and collaboration, future research should focus on these facilitators and barriers.KeypointsEarly diagnosis is essential for the prognosis of RA, and the diagnostic process begins in general practice.Suggested facilitators: training courses in interpretation of laboratory tests and the clinical manifestation of RA, and videos on joint examinations.Suggested barriers: compliance with the gatekeeper function, suboptimal collaboration with rheumatologists, limitations of laboratory tests, and diversity of clinical manifestations.

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