More than 10 million people in the UK have some form of arthritis. It is the leading cause of pain and disability, contributing to tens of millions of working days being lost due to sickness absence associated with the condition. Inflammatory arthritis in particular requires much needed attention as it can start at any age, including in young children, and can cause significant joint damage, loss of work and disability, and higher rates of cardiovascular disease if left untreated. Therefore, early referral and assessment by a rheumatologist specialising in inflammatory arthritis is vital to prevent joint damage and disability.
However, a shocking new report funded by NHS England, commissioned by the Healthcare Quality Improvement Partnership (HQIP) and published by the British Society for Rheumatology (BSR) has found that many people with inflammatory arthritis including rheumatoid arthritis experience significant delays in being referred from primary care to rheumatology departments, plus delays in being seen in secondary care and in starting the treatment they need which can be essential to prevent joint damage and disability.
The report gives details of a national audit of 6345 patients with early rheumatoid and inflammatory arthritis who were seen in 2014-15 in rheumatology departments across England and Wales, and investigates their assessment and secondary care management, comparing the care they received with what is considered best practice recommended by the National Institute for Health and Care Excellence (NICE).
NICE guidelines on rheumatoid arthritis recommend that any person who visits their GP with symptoms of possible inflammatory arthritis should be referred urgently to a rheumatology department within 3 working days, then seen by a specialist within 3 weeks and treatment starting within 6 weeks of being referred.
Surprisingly, the report has shown that only 17% of people with persistently swollen joints were referred by their GP to a specialist within 3 days, and only 38% of people were seen in secondary care within 3 weeks of referral and only just over half (53%) received treatment within 6 weeks. The long-term effects of the delays in treatment are not yet apparent, but it is widely known that the longer the delay in diagnosis and treatment, the worse the long term outcome for people with arthritis will be. And that's not all - these delays could lead to major consequences for the patient and have a knock on effect on their needs for health and social care in the future, with important economic implications.
One way of improving the situation would be to raise public awareness of the symptoms and signs of inflammatory arthritis so that people seek help earlier and feel more confident in asking their GP for a rapid referral. GPs also need better education about who and when to refer urgently and rheumatology services need to investigate ways of increasing capacity to enable them to see patients as soon as possible so that they can be started on treatment, thereby preventing avoidable disability.
Wendy is a Consultant Rheumatologist at North Hampshire Hospitals NHS Foundation Trust and UK Charity Arthritis Action's Medical Advisor.Suggest a correction