Perspectives on Rheumatological Conditions
The Need for early and dedicated Rheumatologic Services
Autoimmune Disease are a major health problem.
Researchers have recognized 80-100 different autoimmune diseases and suspect at least 40 additional diseases such as Parkinson’s may have an autoimmune basis. These conditions are chronic and can be life-threatening.
Autoimmune diseases are one of the top 10 leading causes of death in women in all age groups up to 64 years of age. Autoimmune diseases however face critical obstacles in diagnosis and treatment.
Despite the fact that little is known about autoimmune conditions by the general public and even some health care professionals , statistics comparing it to other diseases show its major impact on health care services and the disparities in care and resources provided to it.
The National Institute of Health, NIH in America estimates up to 23.5 million Americans have an autoimmune disease, AD. In comparison, cancer affects up to 9 million and heart disease up to 22 million.
NIH estimates annual direct health care costs for AD to be in the range of $100 billion (source: NIH presentation by Dr. Fauci, NIAID). In comparison, cancers costs are $57 billion (source: NIH,ACS), and heart and stroke costs are $200 billion (source: NIH, AHA).
But despite these numbers showing its impact, NIH research funding for AD in 2003 came to $591 million. In comparison, cancer funding came to $6.1 billion; and heart and stroke, to $2.4 billion (source: NIH). Understanding autoimmune conditions would benefit other diseases, as understanding how to control the immune system activity will benefit transplant recipients, cancer patients, AIDS patients and even infectious disease patients.
The first rheumatology clinic in Ghana was started at the Korlebu Teaching hospital in 2009 by Dr Dzifa Dey joined later by the late Dr Joan Agama.
Currently, there are only two centres providing dedicated rheumatologic services in Ghana, with the second one in Kumasi. Records in Accra show rising number of patients but no increase in specialist trained.
The importance of having dedicated care cannot be overemphasized. Early diagnosis and treatment are core principles in the management of patients with rheumatic disease. For those with inflammatory arthritis, the benefits of early and adequate reduction in inflammation have been well-demonstrated both from an individual and a socio-economic perspective. Timely and effective treatment increases the likelihood of disease going into remission and continuity of employment in addition to reducing the number of co-morbid conditions such as heart disease and cancer commonly associated with chronic inflammation.
Early institution of treatment greatly improves quality of life when started at an early stage in the disease course.
Despite this knowledge that early treatment is beneficial, many patients with rheumatic disease endure significant delays before first review by a rheumatologist. Worldwide there is a growing shortage of rheumatologists even though large numbers of symptomatic patients are being diagnosed, meaning we have long waiting lists and in some cases up to three months wait to get an appointment to see specialists for conditions that a few days delay can be critical.
Given the evidence that autoimmune and rheumatic conditions are on the rise it is imperative that such services are given the needed attention, manpower and resources. Training more doctors and utilizing other health providers such as dedicated nurse practitioners, physician assistants, providing health facilities with resources to manage these conditions properly before it becomes a major problem on the health care system is a must. There are too few rheumatologic providers currently to meet the health needs of patients.
The writer is a Physician Specialist & Rheumatologist