MPs urge better training of GPs to ensure more rapid diagnosis of rheumatoid arthritis

A major public education campaign alerting people to the symptoms of rheumatoid arthritis and better training for GPs in diagnosing the condition are needed to ensure that treatment starts more quickly to reduce long term disability and joint damage, warns a report from the UK’s parliamentary public spending watchdog.

The report from the Committee of Public Accounts, a cross party group of MPs appointed by the House of Commons to examine public spending, found that the average time from the first symptoms of rheumatoid arthritis to diagnosis and treatment has not improved from the figure of nine months reported in 2003.

Reviewing the NHS’s current management of the disease, the committee found that too many patients are not given a diagnosis early enough and, once given one, do not always receive the treatment and services they need to live as well as possible with the condition.

Edward Leigh, the committee’s chairman, said, “It is not widely known that damage to joints as a result of rheumatoid arthritis can be limited by prompt early diagnosis and treatment. Applied as early as possible, but certainly within three months of the onset of symptoms, appropriate treatment can lead to remission, prevent pain and disability, and help people with the condition to continue working.”

MPs found that the main cause for the delay was a widespread lack of knowledge about rheumatoid arthritis and the benefits of early treatment. Many people with symptoms do not realise that they may have the disease or what the consequences of delaying medical treatment might be, they reported. To improve this they recommend that the Department of Health should run a public education campaign during 2010 to raise awareness of the symptoms of rheumatoid arthritis and highlight the need for prompt treatment.

The report also found that many GPs were not well informed about the disease and find it difficult to distinguish from the many other musculoskeletal conditions they are presented with. On average, people with rheumatoid arthritis visit a GP four times before they are referred, and 20% visit a GP eight or more times before referral.

The MPs found that GPs receive an average of only two hours of teaching on musculoskeletal conditions during their training. They recommend that the health department introduce a targeted campaign or guidance to raise awareness among GPs and other primary care professionals of the importance of referring patients promptly if rheumatoid arthritis or other forms of inflammatory arthritis are suspected. The Royal College of General Practitioners should also be encouraged to provide more training on rheumatoid and inflammatory arthritis when it implements its plan to extend the duration of training of GPs.

The committee found that patients with a diagnosis of rheumatoid arthritis do not always get the services they need and that, as with many other long term conditions, there is a “postcode lottery” of access to care. They found that primary care trusts’ spending on rheumatoid arthritis services ranged from £5.68 (€6.50; $8.80) to £17.58 per person. They also found inconsistencies in the provision of drugs and of multidisciplinary services.

Rapid access to specialist care is not always available when patients with rheumatoid arthritis experience a flare up of their condition, the MPs’ review said.

“The Department should review the evidence on the need for better access to flare-up and pain management services for people with RA [rheumatoid arthritis] and produce an action plan by March 2010,” the report proposes.