Part 26b: Rheumatoid arthritis in primary care.

There is a common belief that rheumatoid arthritis (RA) is prevalent only in countries such as Britain that have a cool, damp climate. This is a myth - RA is common throughout the world. Around 387,000 people in the UK have RA - roughly 0.8% of the adult population - and there are around 12,000 new cases a year. RA affects three times as many women as it does men and the disease most commonly starts between the ages of 40 and 50.1 Almost 9 million people (19% of the population) visited their GP in the past year with arthritis and related conditions.2 The total annual cost of treating RA - including the cost to the NHS and lost working days - is estimated at [pounds sterling]1.3bn.

Care of long-term conditions Primary care has an increasing role in supporting patients with long-term conditions. Many practice nurses have a special interest and expertise in caring for patients with musculoskeletal and rheumatological problems, and RA may coexist with other chronic illness such as diabetes or asthma. There is strong evidence that early intervention can improve the long-term outlook for people with RA.3 However, there is wide variation in the quality of care patients receive.4 Many doctors and nurses working in primary care are involved in shared care, monitoring the disease and modifying drug regimens. Practice nurses' long-standing relationships with patients mean they can offer support, education, advice and quick referral to secondary care if warranted. Where a health professional of another discipline such as a physiotherapist or podiatrist is available in the practice, their skills may also be harnessed for the benefit of the patient. With continuing support people with RA can become active participants in their own care. Practice nurses can support and educate patients, and boost their ability to care for themselves. Patients need to know what RA is and how it might affect them, what treatment is available and how it works, so that they can make informed choices about treatments and management. There is evidence that people who participate in decisions made about their care are better able to manage and cope with their disease than those who do not.5 The extent of patients' involvement in their own care will vary from one to another. Self-help groups and the expert patient programme can be highly effective in empowering patients with a long-term condition such as RA,6 and the practice nurse can …