E23 Pediatric rheumatology in primary care in Tunisia
Authors: Ben Messaoud Faïza , Miladi Saoussen , Bousaa Hiba , Makhlouf Yasmine , Souabni Leila , Ouenniche Kmar , Kassab Salma , Chekili Salma , Ben Abdelghani Kaouther , Fazaa Alia , Laatar Ahmed 
Published: August 2023

Abstract

Background
Primary care medicine is the first line of defence in the management of all diseases, and pediatric rheumatology is no exception to this rule.
The aim of our work was to assess the management of rheumatological manifestations in the pediatric population, particularly in cases of suspected juvenile idiopathic arthritis (JIA).

Methods
A self-administered survey via google forms, was conducted among Tunisian primary care practitioners, during the month of February 2023. They were asked about their usual practice when children with articular symptoms consulted them.

Results
Our work included 33 practitioners, 25 of whom were women and eight men, with a female to male ratio of 3:1 and a mean age of 26 years [25–57]. Eighty-eight percent were family medicine residents (n = 29), nine percent were public health physicians (n = 3) and three percent were private physicians (n = 1). The average number of years in practice was three years [1–26]. Fifty-eight percent (n = 19) practiced in a university hospital, 18% (n = 6) in a regional hospital, 21% (n = 7) in a local dispensary, and three percent (n = 1) in a private practice. Regarding the number of pediatric-aged consultations per week, 70% (n = 23) reported seeing less than five patients and 21% more than ten per week (n = 7). A rheumatological reason for these patients was found in less than five consultations per week according to 94% of practitioners (n = 31). Forty-eight per cent (n = 16) of participants expressed anxiety when asked how they felt about managing a rheumatological case in this population, nine per cent (n = 3) were confident, 21% felt fearful (n = 7), 27% (n = 8) were indifferent and three per cent (n = 1) were alert. Forty-two per cent (n = 14) suspected JIA in a patient. In 77% of cases, the patients were seen repeatedly for polyarthralgia, 47% for arthritis, 18% for spinal pain, and 47% for systemic manifestations. 79% believe that early management of JIA brings a benefit in terms of health costs. When asked about their sources of training in JIA, 76% said it was through clinical courses and nine per cent through medical days, six per cent webinars and workshops and three per cent felt they had not received any training. As for sources of information, 31% through peer groups, 49% on medical websites, 27% through medical journals and 49% through medical school courses. To the question ‘On a scale of 0–5, how would you rate your training in the management of rheumatological manifestations in children and adolescents’ the answers were 0 in 21% of cases, 1 in 42% of cases, 2 in 12% and 3 in 24%. When faced with a suspicion of JIA, 49% of practitioners referred patients to pediatrics, 64% to rheumatology, 55% initiated a biological and imaging work-up and 18% prescribed symptomatic treatment. For the treatment, 67% prescribed paracetamol, 58% NSAIDs, 15% corticosteroids, 9% did not prescribe any treatment and three percent admitted not knowing what to prescribe in this situation.

Conclusion
JIA may affect functional and even vital prognosis of young patients. The detection and early management of the disease depend on the reinforcement of training and awareness for primary care physicians.