Many Rheumatoid Arthritis Patients Get Below-Par Care
Aug. 22, 2000 -- People with rheumatoid arthritis may not be getting the best care available, either for the arthritis or for other illnesses they may have -- particularly if they rely only on primary care doctors for their treatment, a new study indicates.
If they are not doing so already, these patients should start seeing a rheumatologist -- a doctor who specializes in treating rheumatoid arthritis (RA) -- in addition to their primary care physician, say the authors of the study published in the Journal of the American Medical Association.
"Patients need to be aware that the quality of care they're going to receive can vary from doctor to doctor," study author Catherine H. MacLean, MD, PhD, tells WebMD. "They need to be self-advocates and ensure they're getting the highest quality possible. And this study suggests they're going to get higher-quality care from a specialist." MacLean is an assistant professor of medicine at the University of California in Los Angeles.
Rheumatoid arthritis is a disabling, relatively common autoimmune disease that causes progressive destruction of the joints. It tends to develop in young to middle-age adults, but can arise at any age. People with RA have redness, swelling and stiffness of the joints in the shoulders, elbows, hands, wrists, ankles, and feet. A variety of medications are needed to control the swelling, pain and disability caused by the disease.
MacLean and colleagues evaluated data collected from the medical records of 1,179 rheumatoid arthritis patients, with an average age of 52. Most were women, as RA tends to affect women much more than men. Nearly one-fifth of the patients also had another illness, such as diabetes or heart disease.
The authors found that the overall quality of health care provided to these patients over a four-year period "fell far short" of nationally recommended guidelines for their arthritis, as well as for the other diseases they had and for general health maintenance such as cancer screening. But those who saw specialists got far better management of the specific diseases treated by those specialists than those who didn't.
For example, RA patients who saw a rheumatologist not only had annual visits for the arthritis but got blood testing to monitor the disease and the effects of the drugs they took to treat it 76% of the time. Those who saw only a primary care physician, meanwhile, got the appropriate specialized care just 47% of the time.
"I'm glad they came to that conclusion," Theodore Pincus, MD, a professor of medicine and rheumatology specialist at Vanderbilt University in Nashville, Tenn., says of the study results. "I've observed the same thing over the years. A few weeks ago, I saw a physician's father; the man has had RA for three years and has never really gotten the right care."