ObjectiveTo explore the role of the general practitioner (GP) in the treatment of rheumatic diseases with TNF-α-inhibitors.
IntroductionFive TNF-α-inhibitors are approved for the treatment of rheumatic diseases in Norway. They all have potentially hazardous side effects, and their treatment require close attention. The number of users in Norway keeps increasing, and GPs have an important role in the outpatient setting.
MethodsTwo different approaches to the objective were used. The first approach was searching for literature in medical databases and the internet pages of several healthcare organizations. Three main areas of interest to the GP were discovered by the author: adverse events, blood sampling, and vaccination. These were used as a basis to form the search terms. The second approach was contacting 18 Norwegian Departments of Rheumatology by e-mail to obtain their routines concerning prescription of TNF-α-inhibitors.
ResultsThe risk of serious adverse events during treatment with TNF-α-inhibitors compared with control is increased in the short term. A standard set of blood sampling as a part of safety monitoring from a central authority was not found. Recommendations from 10 different rheumatologic departments in Norway and other guideline sources have been summarized.Live attenuated vaccines are generally contraindicated during treatment. Patients are recommended to receive the pneumococcal vaccine and annual refills of the influenza vaccine.
DiscussionThe general practitioners are expected to have responsibility for several of the control functions of treatment with TNF-α-inhibitors. A clarification of these roles is necessary to meet the future needs for cooperation between the first- and second-line health services. This calls for: -a clarification of the responsibility of PHC- and SHC-physicians-a mutual understanding of each other`s roles.