As the NHS reshapes to tackle covid-19, technology can help to further standardise care, lessen variations and enhance remission rates for people living with rheumatoid arthritis, writes Stijn Van Haaren

This article forms part of an AbbVie UK commissioned digital feature package with the Health Service Journal (HSJ). AbbVie has been involved in funding and content decisions and development of this article. Intended audience is healthcare access decision makers in line with HSJ’s readership. Please note, HSJ website (www.HSJ.co.uk) does not have restricted access to this group.

Remission continues to be the desired care goal within rheumatoid arthritis (RA) practice, as people living in remission show a more favourable outcome in terms of quality of life, functionality and structurally (joint damage) compared to those with low disease activity1. However, remission rates in the UK are lagging behind other European countries, with rates of 26 per cent compared to 43 per cent in Spain and 62 per cent in France2. Disparities in care stretch further with variations between UK regions. That being in terms of referral delays, staffing structures or time to initiating treatment, meaning not all patients are able to receive optimal care3.

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As the NHS continues to adapt to covid-19 there are opportunities to further standardise care, reduce variations and improve remission rates for people living with RA. As patients are moving to be treated with both virtual and face-to-face consultations, mechanisms are needed for patients to be able to indicate the status of their disease, and feel equipped with the knowledge and confidence to speak up. It is vital that no patients fall through the gaps.

For healthcare professionals it will be important to monitor patients adequately and they mutually agree care decisions with patients aiming for remission. Remote monitoring solutions, both telephone and video, and electronic patient reported outcomes (ePROMs), will be vital in this. However, challenges remain such as a lack of adequate funding at trust level for ePROMs.

Faster and wider access to a range of effective therapies will maximize the positive impact of these changes and ultimately drive higher levels of remission. The best treatment first approach can ensure patients are in the best possible health early in their disease course, improving quality of life and reducing capacity burden on the healthcare system.

Stijn van Haaren is medical lead, rheumatology, AbbVie UK.

References

1. E. Nikiphorou, SJ Norton, L Carpenter et al., Remission vs low disease activity: function, quality, of life and structural outcomes in the Early Rheumatoid Arthritis Study and Network. Rheumatology 2020;59:1272-1280 doi:10.1093/rheumatology/kez461

2. SA Bergstra, JC Branco, D Vega-Morales et al., Inequity in access to bDMARD care and how it influences disease outcomes across countries worldwide: results from the METEO-registry. Ann Rheum Dis 2018;77:1413–1420. doi:10.1136/annrheumdis-2018-213289

3. British Society for Rheumatology, National Early Inflammatory Arthritis Audit (NEIAA), Second Annual Report (Data collection: 8 May 2019 – 7 May 2020)

Covid could be a catalyst for improving rheumatology services