Intended for healthcare professionals

Rapid response to:

Views & Reviews From the Frontline

Bad medicine: rheumatoid arthritis

BMJ 2011; 343 doi: (Published 05 October 2011) Cite this as: BMJ 2011;343:d6357

Rapid Response:

Re: "Bad Medicine: Rheumatoid Arthritis", Des Spence general practitioner, Glasgow Views & Reviews doi: 10.1136/bmj. d6357

Arthritis Care is the UK's leading organisation working with and for
people with all forms of arthritis. People with arthritis are at the heart
of our work: they form our membership, are involved in all of our
activities and direct what we do.

We are very disappointed and concerned by Dr Des Spence's attempt to
create the impression that Rheumatoid Arthritis (RA) may be being
excessively treated and inaccurately diagnosed. There is very strong
evidence that the problem is exactly the opposite of this. Reports
published by highly reputable and fully independent bodies such as the
National Audit Office and the King's Fund in 2009 clearly highlight this
point in detail (1) , as does the Royal College of Physicians' guidance on
RA (2) commissioned to inform the NICE guidance on RA. The reports
demonstrate that there are low levels of awareness of RA among both GPs
and the general population, and reveals that people with RA typically
delay seeking treatment because they initially deem their symptoms too
mild for them to bother seeking treatment. GPs' uncertainty over a
diagnosis is also identified as a key causal factor for delays.

This results in up to 75% of people with RA experiencing delays in
receiving treatment of up to three months from the onset of symptoms,
incurring great risk of severe joint damage as a result. Effective
treatment has been shown to reduce joint damage and prevent disability.

Arthritis is the biggest cause of physical disability in the UK,
accounting for roughly 1 in 3 GP visits and nearly ?5bn of NHS spending in
2009/2010 (3). It also carries a huge economic as well as human and social
cost, estimated at ?7 billion annually in terms of lost labour in 2007
(4). The NHS simply cannot afford to disregard musculoskeletal diseases
such as RA as just a few aches and pains, or as a low-priority issue.

Dr. Spence's article does not represent the mainstream view of RA
amongst health professionals, nor does it reflect the reality experienced
by most people with RA, and therefore is not only inaccurate but


(1) NAO "Services or people with rheumatoid arthritis", 2009; Kings
Fund, "Perceptions of patients and professionals on rheumatoid arthritis
care", 2009

(2) National Collaborating Centre for Chronic Conditions: Rheumatoid
Arthritis , National clinical guideline for mangement and treatment in
adults RCP 2009

(3) Department of Health, Programme Budgeting Data 2009-10,
Available at:

(4) Fit to Work?, The Work Foundation, September 2007

Competing interests: No competing interests

13 October 2011
Federico Moscogiuri
Head of Policy & Campaigns
Arthritis Care