Effectiveness of General Medicine in the Management of Rheumatoid Arthritis in Rural Settings: A Systematic Review and Meta-Ethnography.

Rheumatoid arthritis (RA) is a global autoimmune disease causing significant morbidity, particularly in rural areas with limited rheumatology care access. Primary care plays a crucial role in early RA detection and management. This systematic review evaluates RA management in rural primary care to identify ways to enhance quality of care. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a meta-ethnography synthesis was conducted on studies from PubMed, Web of Science, and Embase (April 1995-December 2023). Quality was assessed using the best evidence in medical education (BEME) scale, focusing on diagnosis, treatment barriers, and collaboration between general physicians (GPs) and specialists. Of 55 studies, 11 were included. Significant diagnostic delays were linked to patient, physician, and systemic factors. Barriers included limited GP rheumatology training, inefficient referrals, and poor patient-specialist communication. Successful strategies involved GP education, telehealth (e-consults), and collaborative care models. Thematic analysis highlighted patient behaviors, GP knowledge gaps, and the need for interdisciplinary collaboration. Rural RA management faces challenges such as diagnostic delays and limited resources. Key improvements include enhancing GP education, utilizing telehealth, and streamlining referral systems. A multifaceted approach emphasizing the role of primary care in early diagnosis and management is essential to improving RA care in underserved areas.