Rheumatoid arthritis patients beneift from NICE U turn postcode lottery

Faster treatment has been promised for the 20,000 new sufferers of rheumatoid arthritis every year as part of the first nationwide guidance for treating the incurable condition.

The new advice, to be issued by the National Institute for Health and Clinical Excellence (Nice), follows a damning report that found a postcode lottery with wide variations in the way cases of the painful condition were handled.

It also calls for specialist physiotherapy to improve fitness for the 400,000 existing UK sufferers.

Experts said early treatment was key to reducing the effects of the debilitating auto-immune disease in which a person’s joints, particularly hands and feet, are attacked by their body’s own defences. It affects relatively young people and cannot be cured.

A report last year by think tank The King’s Fund found thousands of sufferers were being let down by “unacceptably wide variations” in care by GPs and hospitals, with some patients waiting years for a diagnosis because of a lack of understanding among GPs.

The guidelines will apply throughout England and Wales.

It calls for anyone with suspected symptoms to be referred to a specialist. The referral should be urgent if the small joints of the hands or feet are affected or it has been three months or longer since the onset of symptoms.

Newly-diagnosed patients, which number some 20,000 a year, should be offered a combination of disease modifying antirheumatic drugs as soon as possible, it says.

The 400,000 existing sufferers should have access to physiotherapy to improve their general fitness and learn exercises for enhancing joint flexibility and muscle strength. The guidance also says they should also have access to assessments of the effects the disease – such as pain, fatigue, and inability to work.

Consultant rheumatologist Dr Chris Deighton, who was clinical adviser to the guideline development group, said: “Early diagnosis and referral to a specialist are key recommendations in this guideline – this will help us catch the disease at earlier stage where it may be possible to reduce future damage to the joints with disease-modifying drugs.”

The guidance was welcomed by patients’ groups. National Rheumatoid Arthritis Society chief executive Ailsa Bosworth said that, if widely implemented, it would help patients get the care they need.

“This guideline will help patients understand what constitutes best practice in managing RA, and realise that putting up with unbearable pain doesn’t have to be an option,” she said.

Arthritis Care chief executive Neil Betteridge said that Nice’s “whole-person” approach to treatment represented a “giant leap” for sufferers but must now be backed with adequate resources.

“This guideline ticks a lot of boxes and includes much that Arthritis Care has long campaigned for. However, it must be backed up by the range of services needed in GPs’ surgeries, hospitals, and the wider community,” he said.


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