People with rheumatoid arthritis (RA) should start treatment within three months of onset of symptoms. This determines the effects of treatment, doctors remind. However, in Poland, patients go to a rheumatologist at least a few months too late.
Experts spoke about it on Thursday in the capital city during the debate on the situation of Polish patients with inflammatory joint diseases. Among the main reasons for the delay, they mentioned, inter alia, patients postponing a visit to a doctor, insufficient knowledge of primary care physicians (POZ) about the disease and too low valuation of rheumatology consultations by the National Health Fund (NFZ).
As recalled by the national rheumatology consultant prof. Witold Tłustochowicz, contrary to popular opinion, inflammatory joint diseases affect young people at the peak of their professional activity. They manifest themselves in swelling, pain and stiffness in the joints and lead to irreversible damage to them. Mistaken for them, degenerative joint disease occurs in the elderly.
Overall, about 0,5 million people in Poland suffer from inflammatory joint diseases – assessed the rheumatologist. The most common of these is RA – data show that it affects approx. 220 people. Poles. However, this number may be higher due to underestimated data from rural areas.
Prof. Tłustochowicz pointed out that late diagnosed and poorly treated RA leads to disability and may shorten life. “But when the sick are treated properly and at the right time, they are able to work and live normally” – he explained.
According to prof. Brygida Kwiatkowska, deputy director for clinical affairs of the Rheumatology Institute in Warsaw, the research shows that the only factor deciding whether a patient with RA will achieve remission (i.e. disappearance of symptoms of the disease – PAP) is how quickly we start treating it. The rheumatologist noted that the standard is to include an immunomodulating drug – methotrexate. “We have approximately 9-12 weeks for that,” she emphasized. She added that patients who did not start treatment early have a 2-3 times worse prognosis, and in addition, the costs of their treatment increase significantly.
Meanwhile, it turns out that only 20 percent. RA patients in Europe go to a rheumatologist within three months, who should make a diagnosis and implement therapy. “Research shows that the average diagnostic delay in Europe is 24 weeks (approx. 6 months), and in Warsaw 35 weeks (approx. 8 months)” – said the rheumatologist.
The latest research conducted as part of the campaign entitled RA: Joint the Fight (RA: Join the Action), which covered over 10 patients from five continents and 42 countries (including Poland) showed that patients with RA were diagnosed, on average, 2 years after the first symptoms of the disease.
According to prof. Kwiatkowska, there are several reasons for these delays. First, patients wait an average of six weeks before deciding to see a doctor at all. RA affects young people who are convinced that joint diseases do not affect them, explained the rheumatologist. “If a patient is helped by non-steroidal anti-inflammatory drugs, such as ibuprofen or salicylic acid (aspirin, polopyrin – PAP) and if the ailments do not interfere with his work, the patient postpones the visit to the doctor” – she said.
Another important cause of delays is insufficient knowledge of GPs about the disease. “Sometimes the doctors themselves think that the patient is too young for a disease of the joints and do not refer him to a rheumatologist” – said Prof. Kwiatkowska. They also prescribe medications that bring improvement – for example, further non-steroidal anti-inflammatory drugs or steroids.
According to a rheumatologist, a world study shows that the use of non-steroidal anti-inflammatory and analgesic drugs may be responsible for 60 percent of patients with RA. delays in obtaining adequate therapy.
What is more, if a primary care physician refers a patient with joint problems to a specialist, it is most often an orthopedist, emphasized prof. Tłustochowicz
The study “RA: Join the Fight” shows that Polish patients particularly often use the help of doctors of this specialty – said 27 percent. Polish group, compared to 13 percent. all of the respondents.
“The orthopedist sends the patient to a mass of unnecessary and costly tests, and this again extends the time to diagnosis,” said the national consultant.
Experts estimated that the omission of a family doctor by an RA patient would shorten this time by 20-30%.
Another problem is the low valuation of rheumatology consultations by the National Health Fund. According to prof. Tłustochowicz for such advice, including diagnostics, the doctor should receive at least PLN 70, while the doctor receives PLN 35. Hence, among others, there are delays in access to a rheumatologist (about 2-3 months). As one visit is not enough to perform diagnostics, it must be spread over 2-3 visits.
The consultant also noted that in approx. 10 percent poviats do not have rheumatology clinics at all, and at the same time the total number of such clinics in the country, which have contracts with the National Health Fund, is too large. Many of them do not provide good quality services, and some do not even have a rheumatologist. However, this results in the fragmentation of contracts, the consultant noted.
As he assessed, the best solution would be to create a reference network of rheumatology clinics in the country, which would be appointed by voivodeship consultants for rheumatology. One such center per district would be enough.
“We do not want more money for rheumatology, but we want to spend it wisely” – he emphasized.
Prof. Tłustochowicz told PAP that he had applied for EU funding for the implementation of a computer system that would allow family doctors to quickly refer the patient to a rheumatologist based on symptoms. Medics could also check immediately which reference center is closest to the patient’s place of residence. (PAP)
jjj/ mrt/