Rheumatoid arthritis is a lifelong, progressive, musculoskeletal disease that causes severe pain, swelling and inflammation of the joints, and can lead to reduced joint function and disability. An estimated 580,000 people in England have the disease, with 26,000 new cases diagnosed each year. Annual healthcare costs to the NHS are £560 million, with costs to the economy of £1.8 billion in sick leave and work-related disability.
Too many people with the disease are not diagnosed early enough and, once diagnosed, they do not always get the services they need to help them live as well as possible with the disease. Starting treatment within three months can stop the disease getting worse and yet the time between experiencing symptoms and receiving treatment is typically nine months, unchanged since 2003. The barriers to gaining early treatment arise from people's low awareness of the disease, causing them to delay seeking medical help, and from GPs failing to spot the early symptoms and refer quickly enough for diagnosis by a specialist. People with rheumatoid arthritis visit a GP on average four times before referral, and a fifth visit a GP eight or more times before referral.
People don't always get the services they need once they have been diagnosed and, as for many long term conditions, there may be a postcode lottery of care. There are big variations in spending on rheumatoid arthritis across Primary Care Trusts and access to the range of services needed to manage rheumatoid arthritis varies. There are differences in the quality and breadth of services available, in particular significant gaps in access to psychological services. People also find it difficult getting timely access to help when they experience a flare-up.
Not diagnosing the disease early enough makes it harder for people to remain in work. Three quarters of people with rheumatoid arthritis are diagnosed when of working age, and one third of people stop working within two years of being diagnosed. People with the disease often lack the right support mechanisms to help them maintain their independence and make an economic contribution to society. In November 2008 the Government accepted the finding of a Review of the health of Britain's working age population that steps were needed to help people with musculoskeletal conditions, but this has yet to filter through to action on the ground.
On the basis of a Report by the Comptroller and Auditor General, we examined the Department of Health on: identifying and diagnosing cases of rheumatoid arthritis sooner; providing better support for people living with the disease; and how the NHS can work more effectively to improve services for people with rheumatoid arthritis.