Barriers to Rheumatology-Led Point-of-Care Polarised Light Microscopy for Crystal Arthropathy Diagnosis in Ireland: A Survey of Irish Society of Rheumatology Members

Background and Objectives: Despite evidence demonstrating the advantages of rheumatology-led point-of-care (POC) polarised light microscopy (PLM), it remains underutilised in many hospital settings. We aimed to identify barriers to its use and assess typical caseloads of crystal arthropathy, diagnostic methods and frequency of rheumatology-led POC PLM in practice in Ireland. We also assessed reliance on laboratory-led crystal analysis and the turnaround time for results to be reported. Solutions to improve implementation of rheumatologist-led POC PLM were also explored. Material and Methods: We surveyed 29 rheumatologists registered to the Irish Society of Rheumatology via SurveyMonkey, between May and October 2024. Textual responses were categorised into key themes, and word clouds were generated using Tagcrowd to visualise thematic content. Results: Fifty-five percent of respondents faced challenges using POC PLM for crystal analysis. Common barriers included lack of access to a microscope, lack of a polarising light function and lack of training in performing and interpreting of PLM. Fifty-two percent of rheumatologists highlighted the critical need for accessible and functional microscopes. Ninety-two percent of respondents relied on in-house laboratory crystal analysis. Thirty-two percent received inaccurate or incomplete results from laboratory reports and 28% of respondents reported delays in sample analysis from the laboratory. Laboratory turnaround was 1–2 days for 43% of rheumatologists and 3–5 days for 33%. Sixty-nine percent had not received training on PLM and 48% emphasised the need for improved education on POC PLM, including improved integration into the national rheumatology training. Conclusions: Rheumatology-led POC PLM remains underutilised despite its clinical advantage primarily due to equipment and training deficits. Addressing these barriers through improved infrastructure, education and equipment is essential to ensure effective and timely care for patients with crystal arthropathy.