Systemic autoimmune diseases encompass chronic inflammatory conditions such as systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), systemic sclerosis, Sjögren syndrome, idiopathic inflammatory myopathies, mixed connective tissue disease (MCTD), and undifferentiated connective tissue diseases. Despite advances in their understanding and management, these diseases remain associated with substantial morbidity and mortality [1].

Early diagnosis remains challenging because initial manifestations are often heterogeneous and nonspecific. Diagnostic delay may lead to disease progression and severe organ involvement [2][3]. In this diagnostic pathway, the general practitioner plays a key role by recognising warning signs, initiating first-line investigations, and referring patients early for specialist care. However, a recent review of 47 studies showed that diagnostic pathways in primary care remain characterised by nonspecific presentations, repeated consultations, variable use of investigations, and heterogeneous referral practices [4].

In sub-Saharan Africa, data on the knowledge and practices of primary care physicians in this field remain limited. A recent study conducted in Burkina Faso among GPs and non-rheumatology specialists identified gaps in knowledge regarding RA, highlighting the need to improve the training of non-specialist physicians [5]. Nevertheless, data covering the broader spectrum of systemic autoimmune diseases, particularly from French-speaking West Africa, remain scarce.

The aim of this study was to assess the knowledge, diagnostic practices, referral patterns, and training needs of GPs regarding systemic autoimmune diseases in several healthcare facilities in Senegal.

This multicentre study involving 300 Senegalese GPs yielded three main findings. First, the major systemic autoimmune diseases were frequently reported as known. Second, referral to a specialist was a widely adopted practice. Third, despite an overall favourable perception of undergraduate education, most participants had never received continuing medical education on these diseases.

SLE was the most frequently recognised disease (96%), followed by RA (77%), systemic sclerosis and Sjögren syndrome (66% each), while idiopathic inflammatory myopathies (31%) and MCTD (43%) were less frequently recognised. This heterogeneity may partly reflect differences in the frequency of these diseases in clinical practice and their often polymorphic presentation. Systemic autoimmune diseases may initially present with nonspecific symptoms and involve multiple organ systems, making their recognition particularly challenging in primary care. A recent review of the diagnostic pathway of rheumatic diseases in general practice similarly highlighted the diversity of initial presentations and the heterogeneity of investigation and referral practices [4]. A recent study from Burkina Faso assessing physicians’ knowledge and practices regarding RA also identified knowledge gaps among non-rheumatologists [5].

Diagnostic investigation patterns were among the most important findings of our study. When SLE was suspected, 75.4% of physicians prescribed anti-dsDNA antibodies, whereas only 59.2% requested ANA. In suspected RA, rheumatoid factor was widely prescribed (88.5%), whereas only 28.9% of participants requested anti-CCP antibodies. In addition, 30.8% prescribed anti-dsDNA antibodies when RA was suspected. These findings suggest uneven knowledge of the relative relevance of different autoantibodies. The 2010 ACR/EULAR RA classification criteria include both rheumatoid factor and anti-CCP antibodies in the serological domain [6], whereas the 2019 EULAR/ACR SLE classification criteria use ANA positivity as an entry criterion [7]. Although these criteria are primarily classification criteria and should not be regarded as diagnostic algorithms for primary care, they illustrate the respective roles of these biomarkers in the assessment of these diseases.

A particularly notable discrepancy concerned mixed connective tissue disease. In our study, 65.5% of physicians reported prescribing anti-Scl-70 antibodies when MCTD was suspected. However, anti-U1-RNP antibodies are the major serological marker of MCTD [8]. This finding clearly illustrates the gap that may exist between familiarity with the name of a disease and knowledge of the relevant immunological investigations. It supports educational approaches focused on clinical and immunological reasoning rather than the isolated memorisation of lists of autoantibodies.

Importantly, investigation patterns should not be interpreted solely as indicators of physicians’ knowledge. Contextual factors not assessed in our survey may also have influenced test ordering, including the local availability of immunological assays, access to laboratory facilities, patients’ out-of-pocket costs, and differences in diagnostic resources across healthcare settings. Similarly, referral patterns may have been influenced by the local availability and accessibility of internists, rheumatologists, and other specialists. These contextual determinants should therefore be considered when interpreting the observed diagnostic and referral practices.

Referral to specialists was, however, a favourable finding. When a systemic autoimmune disease was suspected, 91% of physicians referred patients to a specialist, mainly to internal medicine (43.28%) and rheumatology (40.3%). More than half of the participants (53%) also reported participating in shared follow-up with specialists. These findings suggest good awareness of the need for specialist management of these complex diseases. The literature emphasises the importance of early referral of patients with suspected inflammatory rheumatic or systemic disease in order to reduce diagnostic and therapeutic delays [4][9]. Interventions combining the education of primary care physicians, referral criteria, and collaboration with rheumatologists may also improve the timeliness of specialist referral [10].

More than two-thirds of the physicians had previously followed at least one patient until diagnostic confirmation, and 54% reported that treatment was instituted after diagnosis. Corticosteroids and non-steroidal anti-inflammatory drugs were the most frequently reported therapeutic classes. However, the questionnaire did not distinguish whether these treatments were independently initiated by GPs, prescribed following specialist advice, or continued within a shared-care arrangement. These findings should, therefore, not be interpreted as evidence of autonomous GP prescribing. In addition, the survey did not specify the disease involved, disease activity, treatment indication, or monitoring procedures.

The main difficulties reported by participants were long-term patient follow-up (56.8%), limited knowledge of systemic autoimmune diseases (48.7%), and the use of therapies and management of complications (25.7%). These challenges are consistent with the complexity of chronic diseases that often require multidisciplinary management and the use of immunosuppressive therapies requiring specific monitoring.

The need for training is therefore one of the main practical messages of this study. Although 74.3% of physicians rated their undergraduate education as good or excellent, 80% had never attended specific continuing medical education on systemic autoimmune diseases, and 81% expressed an interest in such training. Lack of awareness of available training opportunities was reported by 65% of participants, while time constraints and cost constituted additional barriers. These findings suggest that improving professional skills depends not only on developing new training programmes but also on improving their visibility, accessibility, and compatibility with the professional constraints of GPs. Short, periodic training sessions focusing on warning signs, appropriate use of immunological investigations, and referral indications may be particularly well suited to the needs identified in our population.

Our study has several strengths. It included a relatively large number of GPs and simultaneously assessed several systemic autoimmune diseases, whereas many published studies focus on a single condition. It also provides original data from a West African setting, which remains underrepresented in the international literature.

Several limitations should nevertheless be considered. This was a descriptive study, and the investigator-developed questionnaire did not use a validated score to objectively classify participants’ knowledge levels; formal pilot testing could not be verified in the available records. Responses were self-reported, and face-to-face data collection may have introduced social desirability bias. The sampling frame, exact facility-selection procedure, detailed survey-visit schedule, and numbers of eligible, invited, and declining GPs could not be reconstructed from archived documentation, so a formal response rate could not be calculated. In addition, the original individual-level dataset was unavailable during revision, preventing retrospective verification of item-specific denominators and the exact pattern of missing responses. The survey did not assess contextual determinants such as the availability and cost of immunological tests, laboratory access, or local specialist availability, nor did it distinguish independent GP treatment initiation from treatment prescribed following specialist advice or delivered as part of shared care. Finally, participants were particularly young and had limited professional experience, and national representativeness cannot be assumed. These factors may limit the generalisability of the findings to all GPs practising in Senegal.

This multicentre study shows relatively broad self-reported awareness of the main systemic autoimmune diseases among GPs surveyed in Senegal, particularly SLE and RA. However, considerable heterogeneity was observed in diagnostic practices, particularly in the use of immunological investigations. Referral to specialists appeared to be well integrated into clinical practice, although there remains a substantial need to strengthen GPs’ knowledge and diagnostic skills.

These findings support the development of accessible continuing medical education programmes focused on the recognition of warning signs, the appropriate use of immunological investigations, and referral criteria. Strengthening collaboration between GPs, internists, and rheumatologists could contribute to earlier diagnosis and improved care pathways for patients with systemic autoimmune diseases in Senegal.

Conceptualization: A.C.N. and M.P.; Methodology: A.C.N. and M.P.; Investigation: M.P.; Formal analysis: M.P. and A.C.N.; Data curation: M.P.; Writing—original draft preparation: A.C.N. and M.P.; Writing—review and editing: A.C.N., M.P., A.F., N.D., M.A.N., M.D. and A.P.; Supervision: A.C.N.; Project administration: A.C.N. All authors have read and agreed to the published version of the manuscript.