Early intervention may be key to recovery but it can take four years to see a rheumatologist, reports Fiona Tyrrell
One in 20 Irish people suffer from the painful condition of inflammatory arthritis and run the risk of a lifetime of disability, a multitude of complications and early death, if the condition is not identified in time.
The condition is very treatable and new drugs have revolutionised the management of inflammatory arthritis, giving patients new leases of life.
Rheumatoid arthritis, or inflammatory arthritis, is an auto-immune disorder and, although it is found in people of all ages, it predominately affects people aged between 30 and 50.
It is characterised by painful symptoms such as swelling, stiffness and loss of mobility of the joints.
If left untreated, sufferers run the risk of developing chronic inflammation, which affects not only the joints and causes disability, but is also associated with heart disease, osteoporosis, cancer, work loss, poverty and disability.
"Many of these complications are avoidable with early treatment of arthritis and early detection of potential complications. The early stage of arthritis is important and patients should seek an early opinion on their symptoms, initially from a GP, who can decide if they need to be referred to a rheumatologist," says Dr Gaye Cunnane, consultant rheumatologist at St James's Hospital, Dublin.
The earlier the condition is identified and treated, the greater the chances of remission. Early treatment also means a significant improvement in the quality of life and longevity of patients. This will have major economic implications for patients, many of whom are aged between 30 and 50 and are in their child-bearing and employment years.
They will also have decreased risk of heart disease, cancer and osteoporosis and are less likely to require joint replacements.
The early stage of arthritis (the first one to three months) is called the "window of opportunity" and is the time when treatment is most likely to be effective, according to Cunnane.
Once rheumatoid arthritis becomes chronic, particularly over many years, it often becomes resistant to treatment. Frequently patients at this stage of their disease have a lot of joint damage and the treatments do not work very well, she explains.
Research conducted by Cunnane has revealed that the potential for joint destruction occurs at very early stages in inflammatory arthritis. Some of the enzymes that cause joint destruction can be identified within two weeks of the appearance of symptoms, underlining the need to treat patients with this condition as early as possible.
Despite the clear need for assessment and treatment within weeks of disease onset, some Irish patients are waiting up to four years for a routine appointment to see a rheumatologist.
Patients in some parts of Dublin can wait up to 15 months to see a consultant rheumatologist and some patients in the west of Ireland are waiting four years for a routine appointment.
This delay is a result of existing services being "completely overwhelmed by lack of resources", according to Cunnane. There are currently 19.5 rheumatologist consultants practising in Ireland compared with the 57 recommended in the Hanley Report.
The best way to ensure patients with early symptoms are assessed and treated quickly is through the establishment of early arthritis clinics as is the practice in many other countries, Cunnane says.
There are very strict criteria for these clinics, so that only patients with symptoms and signs of early joint inflammation are referred.
A GP decides if the problem looks like inflammatory arthritis, rather than another musculoskeletal condition such as osteoarthritis or fibromyalgia, which do not need to be referred to an early arthritis clinic.
In such a clinic, patients are assessed by a multidisciplinary team including a nurse specialist, physiotherapist, occupational therapist, a podiatrist and dietician.
An early arthritis clinic is currently operating in St Vincent's Hospital in Dublin, and Cunnane and her colleague, Dr Michelle Doran, are in the process of seeking funding for such a service in St James's. There are no dedicated clinics in the rest of Ireland.
"Rheumatology is a cheap specialty. It does not involve expensive equipment and early intervention is the key to long-term success.
"Unfortunately, there is a lack of public awareness of the concept that arthritis is a treatable condition that affects the young as well as the old. In fact, rheumatoid arthritis usually first presents in young people," she says.
An Tánaiste and Minister for Health Mary Harney will open the Irish Society for Rheumatology's annual conference this Friday, October 14th, at St James's Hospital, which coincides with World Arthritis Week (October 10th-14th).