Early diagnosis key to tackling arthritis

Cutting the waiting time for referrals could reduce the incidence of joint deformities and the need for replacement surgery, writes MARESE McDONAGH

EARLY REFERRAL to a consultant rheumatologist can transform the lives of people with inflammatory arthritis, but some patients have to wait up to two years for an appointment.

A novel initiative launched yesterday aims to cut the waiting time to six weeks, significantly reducing the incidence of joint deformities and, ultimately, replacement surgery for thousands of people every year.

The key to fast tracking diagnosis and treatment for the 8,000 or so people who are struck down with inflammatory arthritis each year, is new documentation which the Irish Society for Rheumatology (ISR) is offering to the 2,500 GPs around the State.

It incorporates a checklist of symptoms which will help to easily identify those patients who will be severely affected by aggressive conditions, such as rheumatoid arthritis, without early intervention. It will also help consultants who are often overwhelmed with referrals, to identify which patients should be prioritised.

It has been estimated that there are 700,000 people in Ireland with osteoarthritis, a degenerative joint disease normally associated with older people and regarded as the “wear and tear” version of arthritis.

But there are a further 100,000 people of all ages, including up to 7,000 children, who have the inflammatory version of arthritis, notably rheumatoid arthritis or psoriatic arthritis. Some of them languish on waiting lists for 18 months to two years, depending on what part of the country they live in.

The ISR initiative will benefit this category by significantly reducing waiting times and, as a result, improving quality of life for the 8,000 new cases each year.

Ireland has just one public rheumatologist for every 100,000 people, making it the lowest consultant-to-population ratio in Europe.

According to consultant rheumatologist, Dr Ronan Kavanagh, the ISR member spearheading this initiative, one per 70,000 people is the ideal ratio. “But I suppose this idea is about making the best of what is available,” he says.

Kavanagh points out that 20 per cent of a GP’s workload comprises people presenting with problems relating to their musculoskeletal system meaning aches and pains in bones, joints, muscles, tendons or cartilage.

The new document being launched by the ISR will be a good guide for GPs and for consultants who should be able to tell at a glance whether a patient has inflammatory arthritis rather than another ailment such as a trapped nerve, pulled muscle or a virus which can often present like rheumatoid arthritis.

A survey of more than 640 GPs conducted by the ISR found that in excess of 60 per cent had difficulty diagnosing some forms of inflammatory arthritis – 29 per cent said they were not confident about diagnosing psoriatic arthritis and 50 per cent said they would have problems diagnosing ankylosing spondylitis, a long-term disease which causes inflammation of the joints between spinal bones and eventually leads to the bones fusing together.

“We love seeing patients early because we know we can help them,” explains Kavanagh. He says treatments have improved so much in the past 15-20 years that outcomes are now much more positive, especially for people who get to a consultant early.

“It is very unlikely that a patient with rheumatoid arthritis will end up in a wheelchair – that is almost unheard of now,” he says. “But an early diagnosis also reduces the risk of joint damage which could result in joint replacement,” he points out.

Women are twice as likely as men to suffer from arthritis, possibly because of a link with changes in hormone levels. Childbirth and menopause can be danger times, doctors believe.

“There are situations where new mums develop acute symptoms in the first few weeks after birth and are so debilitated that they can hardly dress themselves,” Kavanagh says.

The consultant says that a public information campaign advising people to be on the alert for certain symptoms and stressing the importance of early intervention, would be invaluable in helping people to avoid catastrophic joint damage and years of unnecessary pain.

“People of any age should think twice if they develop pain or stiffness, especially if it is associated with swelling of joints which persists for a few weeks,” he urges.

US golfer Phil Mickelson was baffled last summer when he was suddenly struck down with a crippling condition which it seemed might end his career. A week after the US Open he could hardly move.

A visit to the Mayo Clinic confirmed that he had psoriatic arthritis, but an early treatment plan meant he was back doing full workouts within months.

Now he wants to spread the message about the importance of early treatment. “I want to help other people who have situations similar to mine, because it’s very manageable,” he says.