I'm currently in Leeds, UK, visiting Chapel Allerton Hospital. This hospital is home to the Section of Musculoskeletal Disease, a world-renowned clinical academic rheumatology group.
20 rheumatologists from around the world were invited to a course run by the rheumatologists at this leading centre, chaired by Professor Paul Emery. We discussed aspects of rheumatoid arthritis and were encouraged to pick the brains of the Leeds team.
The 1st discussion made enough of an impression to trigger this post.
With rheumatoid arthritis, WHEN you treat is probably more important than WHAT you use to treat?
What do I mean by this statement?
Well, there is clearcut evidence that early diagnosis and therefore early, appropriate treatment of rheumatoid arthritis makes a huge difference to the quality of a patient's life, both in the short and long term.
It is therefore the onus of a rheumatology service to invest in a system for early referral.
Even this renowned rheumatology unit at Leeds needed to start out by trying to get GPs to refer patients early. Many letters to the surrounding 1000s of GPs have been sent, trying to educate and hammer home the message. Lots of talks have been presented and key patient advocacy groups mobilised.
Early arthritis should be treated as an "emergency". The quicker the referral, the quicker treatment is instituted once a diagnosis of rheumatoid arthritis is made, the better the outcomes for the patient, and the health service.
Time from symptom onset to control of disease activity needs to be improved.
We rheumatologists spent so much time arguing the various pros and cons of the different medications we have available to use. We ponder so much about what combinations are best, and we argue over different treatment algorithms to improve the effectiveness of these medications.
But, we also really need to spend time working out how we get the patient who develops symptoms of inflammatory arthritis to see their primary doctor earlier. We then need to work out how we empower this general practitioner to refer to his/her favourite rheumatology service ASAP. And, we need to ensure that the rheumatology service is set-up to be able to fast track review of these patients.
Rheumatologists will need to work harder on strategies to overcome various roadblocks affecting the above.
The WHEN needs to be as quick as possible.