The study assesses the quality of care for patients with long-term health problems

The number of new rheumatoid arthritis diagnoses has dropped by 20% in the first year of the COVID-19 pandemic, new research shows.

The study, published today in Lancet Rheumatology journal by researchers at King’s College London, shows that there may be up to a fifth of new cases that have gone undiagnosed, with cases not having jumped above pre-2020 levels. This suggests that many of these patients were not being screened by your GP or seen by a hospital specialist. However, for patients who were diagnosed during the pandemic, there did not appear to be more delays in starting treatment.

The study assessed the diagnosis and treatment of different types of arthritis in England during the first two years of the pandemic.

Rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis are autoimmune diseases that primarily affect the joints and spine. People with these conditions experience chronic pain that can limit their mobility. If diagnosis and treatment are delayed, these conditions can lead to chronic disability due to joint damage, impaired function, absenteeism and reduced quality of life. Early diagnosis and treatment of these types of arthritis improves patient outcomes. Once diagnosed, patients can begin highly effective treatments to control symptoms and prevent irreversible damage.

Each year, the quality of care for people with rheumatoid arthritis is assessed through a national audit process. However, those audits were halted during the pandemic, making comparisons of care challenging.

Researchers at King’s College London used OpenSAFELY, a highly secure health data platform, to determine how the diagnosis and management of arthritis has been affected by the pandemic. From a study population of over 17 million people in England, they were able to assess the care of 31,000 people with new diagnoses of arthritis between April 2019 and March 2022.

The results showed that the number of new arthritis diagnoses fell by 20% in the year after the first COVID-19 lockdown compared to the year before the pandemic. Arthritis diagnoses fell again as COVID-19 cases rose before returning to pre-pandemic levels by April 2022. Researchers saw no rebound in diagnoses after restrictions were lifted, suggesting there is likely to be a significant burden of undiagnosed patients.

Importantly, the study also showed that for people who were diagnosed during the pandemic, the time to assessment by a hospital specialist was shorter than before the pandemic. This may be due to fewer referrals to hospitals overall and increased use of virtual appointments during the pandemic.

In addition, the proportion of patients who started treatment was similar before and during the pandemic. However, drugs that are considered safer but less effective are being prescribed more often during the pandemic. This may be related to clinicians’ concerns about the effects of stronger drugs on COVID-19 infections.

This study highlights that there are likely to be people with joint pain and swelling who are going undiagnosed as a result of the pandemic. It’s important to talk to a doctor if you have these symptoms, because early diagnosis and treatment of conditions like rheumatoid arthritis greatly improve patient outcomes and increase the likelihood of disease remission.

Dr Mark Russell, lead author of the study, King’s College London

“An important message from this study is that it is possible to assess the quality of care for patients with long-term health problems using routinely collected health data. This approach can be applied to many other chronic health conditions and used to provide feedback to NHS organizations and clinicians to optimize patient care.”

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