The National Audit Office says the government should explore the cost-effectiveness of new initiatives to raise public awareness of rheumatoid arthritis and its symptoms to help increase diagnosis rates and boost overall treatment outcomes in the country.

The call comes following the Office’s investigation into the efficiency and effectives of services in the UK for those with the condition, which has revealed many factors that need addressing in order to help paint a better picture for patients and also save the economy some cash.

In England alone it is estimated that around 580,000 people currently suffer from RA - a progressive musculoskeletal disease that causes inflammation of the joints and severe pain - and there are around 26,000 new cases every year. All in all, the condition is thought to cost the National Health Service £560 million a year, with additional expenses to the economy of £1.8 billion a year in terms of sick leave and work-related disability.

The key finding of the NAO’s assessment of current services is that patients are not diagnosed quickly enough, which is particularly important to outcomes as the earlier treatment is administered the less risk of permanent joint damage and disability. Ideally, patients should be diagnosed within three months of symptom onset, but this is not happening for several reasons, mainly a lack of awareness among both the general public and GPs, the report claims.

The average time from symptom onset to treatment is currently nine months, a figure which has remained flat over the last five years, as patient delays in visiting the GP – sometimes for over a year - are further exacerbated by GPs’ lack of specialist knowledge required to correctly diagnose the disease. In fact, the report found that, on average, patients visited their GP four times before being referred to a specialist for confirmation of the condition and subsequent treatment.

Aside from the obvious benefit to patients, earlier diagnosis of rheumatoid arthritis could also prove to be cost-effective, the report stresses. The NAO’s own economic analysis shows that, if just 10% more patients were diagnosed and treated in the three months following the onset of symptoms, the economy could reap productivity gains of £31 million over five years due to reduced sick leave and lost employment, at a cost to the NHS of £11 million.

Other issues highlighted by the report include: a lack of co-ordination of healthcare professionals and their roles in different areas of the NHS; insufficient access to psychological services, even though depression is often present in RA patients; inconsistent provision of ‘quick response appointments’ to help deal with ‘flare-ups’ of the illness; and poor commissioning of related services by primary care trusts, which are unaware of the number of RA patients in their areas.

More co-ordination
According to Amyas Morse, the head of the National Audit Office, the NHS needs to take “a more co-ordinated approach to identifying people with symptoms of early rheumatoid arthritis, so that they get access to specialist care quickly and receive support and advice to help them manage and live with the disease,” as this would provide “better value for money, better outcomes for patients, and lead to productivity gains for the economy”.

The report makes several recommendations to help improve the overall picture for RA service in the country, including a call to the government to consider a public awareness campaign, a call to health trusts to improve awareness amongst GPs, and the inclusion of the disease in continued professional development programmes for primary healthcare professionals, particularly as GPs are likely to see less than one case of RA a year.

The NRAS has also voiced its support for a public awareness campaign to help earlier detection of the disease. Ailsa Bosworth, its Chief Executive and founder said the charity is “very concerned that RA services are not matching the government’s vision for long-term conditions to be delivered closer to home and are not being commissioned to meet local needs,” and believes a public awareness campaign “would make the public, health professionals and commissioners aware of the urgent need for specialist treatment to prevent rapid irreversible joint damage that can lead to permanent disability and often loss of employment”.