The Path to Better Arthritis Care

It’s a tale of two very different patient outcomes. Just a few years ago, a person experiencing symptoms of rheumatoid arthritis (RA) faced a worrying and uncertain future.

Long waiting lists for consultants meant delays in accessing appropriate treatment, often leading to avoidable joint damage, expensive surgery and a grave impact on every aspect of a person’s work, social and family life.

Fast forward to 2014 and the outlook is brighter. Today, a person developing RA can expect to be prescribed effective treatment within weeks. Thanks to the vast strides made by the HSE’s National Clinical Programme for Rheumatology and the supports and services offered by Arthritis Ireland, people with RA are enjoying healthier lives.

However, although progress has been made in recent years, there’s still a long way to go for Ireland to be recognised as a global leader in rheumatology patient care.

Untitled-1As Arthritis Ireland’s CEO John Church explained: “When Arthritis Ireland first got involved in advocating for better services, Ireland had the worst record in Europe. We had extremely long waiting lists and approximately one consultant per 400,000 people. We’ve learned that quicker access to treatment decreases the risk of disability and also helps to avoid social isolation and unemployment.”

As part of the HSE’s National Clinical Programme for Rheumatology, Arthritis Ireland has been working to inform the strategies around improving rheumatology care in Ireland.

Since the programme’s launch in 2010, seven new public consultant rheumatologists have been appointed, bringing the consultant:population ratio to 1:135,000. This includes the appointment of a second consultant paediatric rheumatologist to Crumlin Children’s Hospital, who is working to treat children with juvenile arthritis.

HSE Clinical Lead

Prof. OIliver Fitzgerald, HSE Clinical Lead

The programme’s clinical lead Professor Oliver Fitzgerald says it’s still not enough, but it’s certainly progress.

“The number of consultants has gone up from 26 to 33”, he explained. “We were never going to get all we needed overnight, and I’d like to bring the number closer to 50, but we’re moving in the right direction.”

The new appointments are mainly outside the Dublin region, making life easier for people in areas which were not previously served by a rheumatologist.

Another major development has been the appointment of 24 specialist MSK physiotherapists who have so far reduced the orthopaedic and rheumatology waiting lists by 20,000.

“Most of those patients would have been triaged to the physiotherapists because
we felt that they had issues which were non-inflammatory in nature so they did not require a consultant. It meant that they were seen faster and given the appropriate advice or treatment and the consultants’ time was freed up for inflammatory patients”, said Professor Fitzgerald.

Another key aim is the development of an efficient primary care service which will allow more patients to be treated in their local community, avoiding long journeys to hospitals.

More nurse specialists will also be needed to deliver the proposed Treat to Target programme which will decrease the chance of the condition progressing by reducing a person’s Disease Activity Score.

Professor Fitzgerald added: “We’re also working on a national model of care for patients with RA and it will be a blueprint for how services will be developed across the country.”

Undoubtedly, there’s a long road ahead for rheumatology services in Ireland, but it’s clear the journey is well underway.

Untitled-3Professor Fitzgerald said: “Waiting lists haven’t been reduced enough but they’re far better than what they were. Fortunately the level of joint damage and disability is something we’re not seeing any more. The initiatives we are proposing now will ultimately save money because if we can implement a programme of early intervention and care, we can reduce the number of expensive therapies and surgeries. We’re a long way from saying that a patient developing RA anywhere in the country will receive a certain standard of treatment, but we have made good progress.”

As well as advocating for better healthcare services, Arthritis Ireland’s Living Well with Arthritis programme has empowered thousands of people to play a more active role in managing their arthritis.

The organisation is also funding two dedicated Chair of Rheumatology research posts which will lead to new, more effective treatments. And its work with the Irish College of General Practitioners has helped educate GPs to recognise and respond to the early symptoms of arthritis.

This article is taken from Issue 5 of Arthritis Ireland’s Big News magazine. You can receive this magazine by Becoming a Friend of Arthritis Ireland.Become a Friend Now.