The British Society for Rheumatology (BSR) and the National Rheumatoid Arthritis Society (NRAS) have jointly issued the report, “Rheumatology in Wales: The State of Play,” exploring rheumatology services in Wales from both clinical and patient perspectives across all rheumatic and musculoskeletal disorders (RMDs). The report raised concerns for Welsh arthritis services and calls for support to improve long-term outcomes for RMD patients, including those with rheumatoid arthritis (RA).
According to the report, the number of patients referred to rheumatology departments in Wales has increased by 66 percent since 2012; however, according to both patients and clinicians, services are not keeping up with the demand. As a result, new patients are waiting longer to be seen by a specialist, while existing patients are struggling to ensure they have follow-up appointments and self-management advice.
The report states that RMDs, which are treated by rheumatology multidisciplinary teams (MDT), encompass over 200 conditions. These conditions are the biggest cause of the growing burden of disability in the United Kingdom, affecting over 10 million adults and 12,000 children.
Musculoskeletal conditions are the most common type of self-reported illness, accounting for 20 percent of general practitioner (GP) appointments. The Welsh Health Survey, conducted in 2015, found that 12 percent of the adult population reported being treated for arthritis. This is almost equal to those treated for mental illness (13 percent), and is significantly higher than for diabetes, reported at 7 percent.
The number of patients receiving a rheumatology specialist consultation within six weeks of GP referral fell by 39 percent as of June 2016, the report states. In addition, only 22 percent of RA patients in Wales were seen by a specialist within three weeks in 2016, compared to the U.K.’s average of 37 percent.
Wales has the lowest number of Early Inflammatory Arthritis (EIA) Clinics compared to the rest of the U.K., a fact that also contributes to service delays.
But, the report notes, compared to the U.K. average of 20 percent, Wales is the best performing U.K. region for GP referrals, with 46 percent of patients with a recent diagnosis of RA being referred by their GP’s within there days of first presentation.
A fair number of patients (40 percent), however, thought intervals between consultations were too long for them to control their condition, and 35 percent said they found it difficult to get an appointment with a rheumatology specialist.
In addition, just more than half of all Welsh patients (52 percent) were advised about their RA and self-management practices within one month of diagnosis, compared to a U.K. average of 67 percent.
When asked about support for rheumatology services or organizations, 35 percent of NRAS members stated they were not given any information about where to seek help, and 30 percent said they were never asked about the emotional impact of their condition.
“These results are worrying and show that NHS Wales and Local Health Boards need to support rheumatology services to meet quality standards for the treatment of RA,” Rich Flowerdew, Welsh Ambassador for NRAS, said in a news release. “It is abundantly clear that patients are not being seen enough within the 12-week window of opportunity of diagnosis. If patients are seen to within this window, their longer-term outcomes look better.”
Early diagnosis and treatment of arthritis is considered critical in avoiding long-term disability, which can lead to unemployment and further healthcare burden.
This report combined information from sources that including the National Clinical Audit for Rheumatoid and Early Inflammatory Arthritis, and an NRAS survey conducted in 257 RA patients about their perspectives regarding healthcare in Wales.
The BSR also consulted GPs, consultant rheumatologists, physiotherapists, and specialist nurses working in Wales.
This report is the third of four undertaken or planned by the BSR. The first, called “The State of Play in Rheumatology: Insights into service pressures and solutions,” conducted in 2015, emphasized the status of rheumatology services across the U.K. The next, “Rheumatology in Scotland: The State of Play,” was launched at a meeting of the Scottish Parliament’s Cross Party Group on Arthritis and Musculoskeletal Conditions in 2016. The fourth report, scheduled for next year, will focus on services in Northern Ireland and provide information about the differences and similarities in care provision across the U.K.