Friday 20 April 2018

A 'right person, right place, first time' approach to treating Rheumatic disease

There are about 100 types of arthritic conditions with symptoms ranging from mild to severe.
There are about 100 types of arthritic conditions with symptoms ranging from mild to severe.

Professor Oliver FitzGerald

Arthritis and rheumatic conditions are one of the biggest sources of disability for Irish people, both young and old. And while in the past their pain and discomfort could be prolonged by lengthy hospital waiting lists to see consultants, a new programme has been making great strides in quickly treating symptoms and showing patients how best to manage their condition.

Arthritis is inflammation of one or more of your joints. The main symptoms are joint pain and stiffness, which typically worsen with age. The two most common types are osteoarthritis and rheumatoid arthritis.

There are about 100 types of arthritic conditions with symptoms ranging from mild to severe. Identifying the condition and treating it as early as possible will ensure patients have the best chance of managing these conditions and help to prevent the development of more chronic musculoskeletal or MSK symptoms.

This is what the National Clinical Care Programme for Rheumatology, set up by the Royal College of Physicians in collaboration with the Health Service Executive, aims to do. The programme has set up an initiative which aims to give people with these conditions greater access to vital services. To date, the Musculoskeletal Physiotherapy Initiative, has enabled 25,000 people who were on waiting lists to see an orthopaedic or a rheumatology consultant, to be seen and successfully treated for their condition by a Musculoskeletal Clinical Specialist Physiotherapist (MSK CSP).

The introduction of the MSK CSPs has yielded the greatest benefits for patients with back pain, hip or knee complaints. International evidence suggests that up to 78pc of such patients can be treated successfully by MSK CSPs and our own data bears this out.

We have also surveyed patients about the MSK physiotherapy services being provided and I am happy to say that 98pc of them rated it as excellent or very good.

Your local GP is the first person to contact to access this service. They will refer patients with these conditions to the local rheumatology or orthopaedic service for further assessment. Once the referral has been made, a team that includes an orthopaedic surgeon or a rheumatologist and a highly trained MSK CSP, will consider the information provided by your GP. This service is free of charge and can be made available to all patients suffering with rheumatic disease.

The programme is helping a wide range of people. It includes a 72-year-old patient who is now suffering from advanced osteoarthritis. She was initially referred to a specialist by her GP three years ago. After a wait of over six months she met with a consultant, had an x-ray and an injection to alleviate her symptoms which helped for a while. Unfortunately the pain returned again earlier this year. This time, her GP was able to directly refer her to the MSK clinic at St. Vincent's University Hospital.

There, she settled on a plan that combined a series of exercises with pain-killing injections and anti-inflammatory medication. So far her mobility has improved and her aches and pains are being controlled.


Professor Oliver FitzGerald is Clinical Lead, National Clinical Programme for Rheumatology

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