Nearly 60 per cent of Ontario residents with rheumatoid arthritis don’t receive timely access to specialists, according to a new report, even though powerful drugs are now available to treat the condition and doctors know early treatment is critical.
Rheumatoid arthritis is a debilitating autoimmune disease that causes painful joint inflammation. The issue of timely access to a specialist is significant because, if left untreated, the disorder can lead to bone erosion, joint deformity and disability.
“This is a chronic condition,” said the report’s lead author, Gillian Hawker, physician-in-chief of medicine and rheumatologist at Women’s College Hospital in Toronto.
The report, released Tuesday by Toronto-based St. Michael’s Hospital, the Institute for Clinical Evaluative Sciences and Women’s College Hospital, also found that among women, age, income and address has a major impact on when she will see a rheumatologist.
Women of child-bearing age are less likely to see a rheumatologist within a one-year period compared with those age 45 and older, while fewer low-income women see specialists within a year than higher-income women. A shortage of rheumatologists across the country also means people living in certain communities may not have access.
Researchers examined provincial health data to determine how many people have been diagnosed with rheumatoid arthritis and how long it took them to see a specialist. Dr. Hawker said the data don’t capture how many Ontarians have undiagnosed rheumatoid arthritis, meaning the number of people with the disease who aren’t being treated is underestimated.
The report says about 55,000 women and 22,000 men have been diagnosed with rheumatoid arthritis in Ontario.
Although the report is based on Ontario data, the researchers say that undertreatment of rheumatoid arthritis patients is a problem across the country.
One of the main issues preventing timely access to treatment is that many patients, as well as their doctors, fail to recognize the serious nature of rheumatoid arthritis because the disorder is often dismissed as a sign of aging, Dr. Hawker said.
“Even when [patients] go to their doctor and say ‘My knees hurt’ or ‘My wrists are hurting’ they often get explained away,” Dr. Hawker said. “It’s not just aches and pains.”
There is also a shortage of rheumatologists across the country, meaning people in some areas – particularly remote, rural parts of the province – may not have access to a specialist.
It’s frustrating, Dr. Hawker said, because there are several treatments available that can prevent the joint damage and disability associated with rheumatoid arthritis. It is a disorder in which the body attacks itself. Now, patients have access to powerful cancer drugs that can stop the progression of rheumatoid arthritis before it causes permanent disabilities. (Rheumatoid arthritis should not be confused with osteoarthritis, a more common condition in which joints can become damaged from the wear and tear of the aging process.)
Dr. Hawker said that governments haven’t addressed the importance of rheumatoid arthritis and other musculoskeletal conditions in the same way as diabetes or cancer. Even though musculoskeletal conditions are the leading cause of disability in Ontario and a huge burden on the health-care system, policy makers have failed to make the treatment of them a priority, she said.
“It’s a problem from coast to coast,” Dr. Hawker said. “I really think the government’s got to wake up.”
The findings are part of a multiyear study examining women’s health and various factors that affect it, such as socioeconomic status, geography and ethnicity. The study is called the Project for an Ontario Women’s Health Evidence-Based Report, or POWER, and is funded by an agency of Ontario’s Ministry of Health and Long-Term Care.
Researchers looked at issues surrounding rheumatoid arthritis and women, as well as other musculoskeletal conditions, such as osteoporosis and osteoarthritis. They found musculoskeletal conditions are undertreated and don’t receive attention from policy makers or health experts.
People with rheumatoid arthritis and other conditions affecting bones, muscles and joints are more likely to affect older women with lower income and education levels.
Women are twice as likely to develop rheumatoid arthritis as men, and are also more likely to experience disability as a result.
Lynn Robinson, a 45-year-old assistant Crown attorney who works in Kitchener, Ont., started to experience the symptoms of rheumatoid arthritis in early 2008. Within a few months, she had difficulty performing daily tasks or even getting out of bed.
“I couldn’t feed myself. I couldn’t drive a car,” she said. “It was awful … I literally could not function.”
After pushing her family doctor, Ms. Robinson was referred to a rheumatologist but was told she would have to wait nine months for an appointment. She began speaking to people she knew about her predicament and was able to secure an earlier appointment with a different rheumatologist who prescribed several medications.
Although she said the medication causes her to become tired quickly Ms. Robinson is now able to work and be physically active, including running a half-marathon in May.
“The quality of life is fantastic,” she said.
Lynn Moore, director of public affairs with the Arthritis Society, said more research funding should be dedicated to understanding the various forms of arthritis because they affect millions of Canadians and have a serious impact on their quality of life. Unlike diseases such as cancer, the public doesn't have a good understanding of how devastating rheumatoid arthritis and other musculoskeletal conditions can be, and many patients are still embarrassed to admit they have it, she said.
“It's very frustrating,” Ms. Moore said. “[Arthritis] is a serious constellation of diseases and … there is a lot more that can be done on the individual and the societal level to really fight the disease.”