One in five patients missed out on a rheumatoid arthritis diagnosis during COVID

One in five patients missed out on rheumatoid arthritis diagnosis in COVID
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A new study by Kings College London has found that the number of patients receiving their rheumatoid arthritis diagnosis fell by 20% in the first year of the COVID-19 pandemic.

The study showed there could be as many as one-fifth of patients who missed out on rheumatoid arthritis diagnosis during the pandemic. This is resulting from patients not being seen by their GP or reviewed by a hospital specialist. However, for patients who were diagnosed during the pandemic, there did not appear to be any delays in treatment.

The study is published in The Lancet Rheumatology journal and evaluated the diagnosis and treatment of different types of arthritis in England during the first two years of the pandemic.

What is rheumatoid arthritis?

Rheumatoid arthritis is a long-term condition, that causes pain, swelling and stiffness in the joints. It usually affects the hands, feet and wrists.

It is an autoimmune condition, meaning that the immune system starts attacking healthy body tissue. Normally, your immune system makes antibodies that attack bacteria and viruses, helping to fight infection; but autoimmune conditions that challenge this process.

Receiving a rheumatoid arthritis diagnosis can be difficult as the symptoms mimic many conditions that also cause stiffness and inflammation. Individuals who suspect this condition can see a GP, blood tests, rheumatoid factor and anti-CCP antibodies, joint scans, and assess their physical ability.

Each year, the quality of care for people with rheumatoid arthritis is benchmarked through a process of a national audit. These audits were paused during the pandemic.

Rheumatoid arthritis diagnosis and management

Researchers from King’s College London used OpenSAFELY, a highly secure health data platform that determines whether rheumatoid arthritis diagnosis and management were affected by the pandemic. They studied over 17 million people in England and evaluated the care for 31,000 people with new diagnoses of arthritis between April 2019 and March 2022.

The results showed that several newly recorded rheumatoid arthritis diagnosis was affected by the first COVID-19 lockdown, relative to the year before the pandemic. They fell as COVID-19 cases rose, before returning to pre-pandemic levels by April 2022. Researchers did not see a rebound in patients receiving a rheumatoid arthritis diagnosis after restrictions were lifted, suggesting that there is likely to be a substantial burden of undiagnosed patients.

Importantly, the study showed that for people who received a diagnosis during the pandemic, the time to get an assessment by a hospital specialist was shorter than before the pandemic. This may be a result of fewer hospital referrals overall and increased utilisation of virtual appointments during the pandemic. This could relate to clinicians’ concerns about the effects of stronger medications on COVID-19 infections.

Lead author Dr Mark Russell, from King’s College London, said: “This study highlights that there are likely to be people with joint pain and swelling who remain undiagnosed as a consequence of the pandemic. It is important to speak to a doctor if you have these symptoms, as early diagnosis and treatment of conditions such as rheumatoid arthritis greatly improves outcomes for patients and increases the likelihood of disease remission.

“An important message of this study is that it is possible to assess the quality of care for patients with long-term health conditions using routinely collected health data. This approach could be applied to many other chronic health conditions and be used to provide feedback to NHS organisations and clinicians, with the aim of optimising care for patients.”


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