The doctor is in
A new type of online screening could help rheumatoid arthritis sufferers get treatment sooner.
Story by Tara Narwani/Illustration by Warren Heise
Mention of rheumatoid arthritis conjures up images of gnarled knuckles and twisted feet-joint deformities that can limit one's ability to perform such simple tasks as eating and walking. The disease also significantly reduces life expectancy: rheumatoid arthritis patients die 10 years earlier on average than healthy people, usually as a consequence of heart attack or stroke.
But according to Dr. Walter Maksymowych, AHFMR Scientist and rheumatology professor at the University of Alberta, these dire outcomes aren't inevitable. Drug treatments can help patients manage their disease. The problem is that patients are just not getting the drugs soon enough. "Six to nine months' delay in diagnosis can have a substantial impact on the rate of progression of the disease," he warns. "The more you delay, the worse the outcome." In many patients, doctors can see evidence of irreversible damage to joints in the hands and feet as early as one year after onset of the disease. Using new opportunities in electronic media, Dr. Maksymowych is leading Alberta's efforts to change healthcare delivery for these patients.
Given that the timing of the diagnosis is crucial for the effective treatment of rheumatoid arthritis, what causes the delay? To begin with, there are about 100 different types of arthritis, broadly defined as inflammation of joints. Some types are acute, caused by infection or injury. Others are chronic. In rheumatoid arthritis, one of the chronic forms, the body's own immune system keeps attacking the joint, and the associated inflammation persists. Family doctors are faced with the difficult task of distinguishing between these types of arthritis after receiving little training in musculoskeletal medicine at medical school. If family doctors refer patients to rheumatologists for follow-up, waiting lists can be months long.
An additional problem is that many people don't have family doctors. Some seek medical advice-even try to self-diagnose-from Internet sources, often finding misleading information that prevents them from receiving proper diagnosis and treatment.
To overcome these hurdles, Dr. Maksymowych, in partnership with other Alberta rheumatologists, recently launched an online screening tool: www.arthritisdoctor.ca Visitors to the website complete a questionnaire which gives them a score indicating the likelihood that they have rheumatoid arthritis. The goal is to get patients into specialists' offices during the early stages of rheumatoid arthritis.
The questionnaire is currently being tested to ensure that it can identify patients with rheumatoid arthritis accurately. Patients referred to Dr. Maksymowych's clinic are first asked to visit the website and determine their score. This score will then be compared to one the patient receives after a thorough physical examination, in the hope that the assessments match.
A patient's score from www.arthritisdoctor.ca is not a formal diagnosis. Rather, it indicates the urgency with which patients should follow up on their symptoms. The website depicts the score as a light on a traffic signal. "Red means you really ought to go see your doctor, and don't waste any time doing it," Dr. Maksymowych explains. "Amber means that there could be a problem, and although you don't need to go right away, you should probably go. And green? If you're still worried, go see your doctor, but it doesn't seem like there's a problem."
Once the testing is complete at the end of this year, Dr. Makysmowych wants to rank patient scores based on medical need. Patients who receive a "red light" score could be seen in his clinic within two weeks, instead of six months, receiving significantly earlier access to such treatments as the commonly used drug methotrexate that helps control the progression of the disease.
Ultimately, Dr. Maksymowych and his colleagues want to know whether this new system will benefit the patient. "Do those people who come in early because they've used the screening tool see an improvement in terms of joint function and quality of life and their overall long-term assessment?" Medical data on patients who used the screening tool will be compared with the data of those who went through the standard referral process.
Dr. Maksymowych is optimistic. "Better healthcare delivery in terms of access and the availability of effective treatment will, I'm quite certain, eliminate rheumatoid arthritis as a serious disease from our community in about five years."