Rheumatoid arthritis delays criticised
pharmafile | July 16, 2009 | News story | Sales and Marketing |Â Â NHS, RAÂ
An official report into the treatment of people with rheumatoid arthritis (RA) has criticised a lack of co-ordination between different parts of the NHS.
The National Audit Office (NAO), looking at the economic effects of the disease, says too many sufferers are not being diagnosed or treated quickly enough.
This delay is "detrimental to patients' health, their quality of life and, with three quarters of people of working age when diagnosed, the economy".
Sick leave and work-related disability for RA sufferers costs UK plc £1.8 billion a year and the NHS £560 million in treatment.
The autoimmune condition is incurable, but treatment can slow the destruction of joints, damage to the lining of heart and lungs, and inflammation of glands.
The NAO calculates productivity gains of £31m over five years if 10% of people with RA (around 2,600 patients) were treated within three months of symptom onset, the clinically recommended time.
The cost to the NHS of such a measure would be £11m, it says.
"The average time for treatment to start is currently nine months, and that's been so since 2003," says Edward Leigh MP, chairman of the committee of public accounts.
"The NHS therefore needs to get better at identifying people with RA and making sure they get prompt treatment."
The report points out that public awareness of the disease is low, despite the fact that severe RA can shorten life expectancy by six to ten years – a similar impact to diabetes, stroke or coronary heart disease.
Between half and three quarters of people with RA delay a visit to their GP for three months after they have noticed symptoms, and a fifth do not seek medical help for a year or more.
The NAO estimates that approximately 580,000 adults in England currently have the disease with a further 26,000 new cases diagnosed each year.
But failing to identify the disease quickly enough affects both long-term outcomes and people's ability to work, the report says.
"The NHS should take a more co-ordinated approach to identifying people with symptoms of early RA, so that they get access to specialist care quickly and receive support and advice to help them manage and live with the disease," said NAO head Amyas Morse.
Much of the blame in the report is put down to inconsistent co-ordination of the roles and activities of staff, "for example between GPs and hospital specialists".
Few doctors have the specialist knowledge to diagnose RA, so patients on average visit their GP four times before being referred to a specialist for diagnosis and treatment.
Provision for the mental well-being of patients also comes under fire from the NAO as depression is common among RA sufferers.
"Many patients do not have sufficient access to psychological services," the report says.
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