Ontario study finds the number of rheumatoid arthritis patients has more than doubled in 15 years

31/01/2014

Over a 15-year period, the number of rheumatoid arthritis (RA) patients has more than doubled with no increase in the number of practicing rheumatologists according to new research from the Institute for Clinical Evaluative Sciences (ICES) which was funded in part by the Canadian Institutes of Health Research and supported by the Ontario Best Practices Research Initiative (OBRI).

The findings, published today in the Canadian Journal of Public Health, show RA prevalence increased with age and was highest amongst females.

“The increasing prevalence of RA and no simultaneous increase in the number of practicing rheumatologists means many rheumatologists are unable to accept new patients due to the heavy burden of followup care required by these patients. The significant rise in the number of people with RA in Ontario calls for prompt action to prevent further strain on our healthcare system and ensure that all RA patients receive timely care,” says Jessica Widdifield PhD, lead author of the study and post-doctoral fellow at ICES.

RA is considered a chronic, life-long disease and rheumatologists are required to provide decades of care for individual patients. National clinical practice guidelines recommend that RA care should include rheumatologists.

The population-based cohort study in Ontario from 1996 to 2010 found:

RA affects approximately one per cent of the adult Ontario population, with around twice as many women as men being affected.
The number of patients living with RA in Ontario has more than doubled (from 42,734 patients in 1996 to 97,499 patients in 2010).
Factors contributing to the increase may include the aging background population and increasing survival of people with RA.
The highest prevalence estimates were observed in the North East, where the density of practicing rheumatologists is among the lowest in the province, highlighting the need for a regional focus when planning for healthcare provision for RA.

“Since health human resources have not kept pace with the growth in RA, newer, more efficient models of care involving allied health professionals and family physicians working in shared-care models could allow better triaging and the co-management of stable RA patients,” says Dr. Vandana Ahluwalia, study co-author, rheumatologist and former president of the Ontario Rheumatology Association.

The researchers add greater shared care would give rheumatologists the opportunity to see new and more complex patients more efficiently. Care structures could also be expanded to include other care providers, such as nurse practitioners, physiotherapists, occupational therapists, and pharmacists, to provide education and care in a more coherent and organized way. With the aging population, better musculoskeletal training for primary care physicians also is important to promote earlier recognition and treatment of RA and other inflammatory conditions.

“This research underlines why we need to rethink the delivery of rheumatology care in Ontario,” says Ahluwalia.

The study “The Rising Burden of Rheumatoid Arthritis Surpasses Rheumatology Supply in Ontario,” was published today in the Canadian Journal of Public Health.

Authors: Widdifield J, Paterson JM, Bernatsky S, Tu K, Thorne JC, Ahluwalia V, Ivers N, Butt D, Jaakkimainen RL, Tomlinson G, Bombardier C.

ICES is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy.

For the latest ICES news, follow us on Twitter: @ICESOntario

The Ontario Best Practices Research Initiative (OBRI, www.obri.ca) led by Dr Claire Bombardier, Canada Research Chair in Knowledge Transfer for Musculoskeletal care is a collaboration of multiple stakeholder groups representing rheumatologists, patients and researchers who are interested in the optimal care management of Ontarians living with RA.