Despite being a highly common condition, there is no known cause or cure for rheumatoid arthritis, writes David Amess MP
Having spent time over the summer working in conjunction with the National Rheumatoid Arthritis Society, a newly established charity which has just celebrated its first birthday and a very solid year of achievement for people with RA, I was particularly pleased to have the opportunity of writing this article. Having just registered the APPG, both NRAS and I felt we needed to inform about a disease which, although very common, is frequently misunderstood by the general public - and I include MPs and members of the House of Lords.
Bearing in mind that the disease is a lot more prevalent than Leukaemia and Multiple Sclerosis, awareness of the severity of the condition tends to be in the main restricted to those who are directly or indirectly affected.
Overview
Rheumatoid arthritis (RA) is a chronic, progressive and disabling condition affecting about one per cent of the UK population. It is an incredibly painful condition, often causing severe disability and ultimately seriously affecting a person's ability to carry out everyday tasks. The disease can progress very rapidly, causing swelling and damaging cartilage and bone around the joints. Any joint may be affected but it is commonly the hands, feet and wrists. It affects approximately three times more women than men and onset is generally between 40-60 years of age although you can get the disease at any age. There are 15,000 children under the age of 16 with the juvenile form of the disease. It has no known cause or cure.
Social Factors
The main symptoms of RA are pain, fatigue and loss of movement. The seriously crippling nature of this condition means that 42 per cent of RA patients are registered disabled within three years, and 80 per cent are moderately to severely disabled within 20 years of diagnosis. This severely limits a person's ability to carry out normal daily tasks, such as looking after children, driving and cooking.
RA can also prevent people of employment age from working. In 1999-2000 9.4 million working days were lost in the UK because of RA. Social factors such as this and the other debilitating effects of RA can severely decrease a person's quality of life. The government considers quality of life a priority, but is slow to recognise the impact of RA.
Restrictions of Services and Treatment
Rheumatology services are, in many areas, under funded and over stretched, The British Society for Rheumatology (BSR) and the Royal College of Physicians (RCP) advocates one Rheumatologist per 85,000 head of population. However these guidelines are not met anywhere in the UK.
The extensive multi-disciplinary teams needed for treating patients in primary and secondary care settings and other supportive services related to people with RA are often not taken into account when assessing the cost of care.
There is still a postcode lottery that can prevent the early diagnosis and treatment of people with RA who have to wait longer and longer for access to treatment. In October last year, the Prime Minister said: "Rheumatoid Arthritis is a very debilitating condition. Under the present system, there is post code prescribing and health authorities may make different decisions for patients in different parts of the country." Figures from the Arthritis Research Campaign show this.
Patients should be referred early to ensure treatment begins as soon as possible, limiting damage to joints. Patients should also be closely monitored to see how they respond to treatment in order to determine whether alternative treatments and/or therapies should be introduced. Early diagnosis and treatment can also reduce the amount of time that patients have to spend in hospital, freeing up the care time and services for those that are most in need of it.
Educating the professionals and the patient
People have the right to know about the treatment options available to them so they can demand the best care available. The government's view is that by empowering the patient with information about their illness, and enabling them to take an active part in the decisions surrounding their treatment, better all round healthcare can be achieved. The National Rheumatoid Arthritis Society play a vital role here with the provision of a website giving extensive information of value to those with the disease and their families. They also act as patient advocates to campaign for access to appropriate treatment for those people who are having difficulty gaining treatment or drugs which they need.
The Burden to Society
RA often shortens life expectancy by around 6-10 years, which equates to that of Hodgkin's disease, strokes and triple vessel coronary artery disease. Such a reduction of life expectancy has a direct economic effect on society. "Research has shown that if average life expectancy could be increased by five years (i.e. to Japanese levels) then GDP in the UK could be between £3 billion and £5 billion a year higher," Wanless Report, April 2002
Rheumatology services in hospitals amounted to £259 million in 2000. A vast amount of this expenditure is hip and knee replacements (frequently for those with Osteo-arthritis, a quite different disease), the majority of which take place due to arthritic damage of the patient's joints.
A number of other economic factors including non-medical, indirect social costs and quality of life factors should be considered. They include:- Loss of production, social activities and leisure activities- Transport costs for patients, out of pocket expenditure such as aids and disability adaptation- Pain, suffering and a reduction in ability to carry on everyday life- Isolation, loss of income, depression and fatigue requiring the attention of more services and support.- Impact on family life and relationships - for instance, there is a higher divorce rate amongst people with RA.
Treatment Options
There are several medications which are generally used in combination to relieve the symptoms of RA. These include:- Non-steroidal Anti Inflammatory drugs (NSAIDs)- Cyclo-Oxygenase-2 (COX-2) inhibitors- Disease-Modifying Anti Rheumatic drugs (DMARDs) including steroids- Biologics drugs including Anti-TNF alpha drugs and lnterleukin 1 antagonists.The early prescription of treatment for RA and the close monitoring of the person's progress are vital to ensure the person's condition is managed in the most appropriate way for them.
