Rheumatology at the general practitioner/hospital interface: a study of prevalence and access to specialist care

Article Abstract:

Patients with rheumatic diseases who attend rheumatology clinics have the benefit of being cared for by physicians with special skills, knowledge, and insight into both rheumatic disease processes and the particular problems of affected patients. Rheumatic clinics are not evenly available in the United Kingdom, which has a nationalized health service. Access to clinics is poor in many areas, and referral rates of patients with rheumatic diseases are often low. Referrals may also be affected by disease prevalence, cost, and the perceived benefits of specialist care. The prevalence of rheumatic diseases in the west of Scotland and the effects of accessibility to specialists were evaluated. The total number of patients served by the 4 physicians in the region was 23,300. The prevalence of rheumatoid arthritis was 0.56 percent; 2.36 and 2.23 percent of the patients had localized and generalized osteoarthritis, respectively, and 0.26 percent had gout. Several cases of three other rheumatic diseases were also present. Two physicians felt that access to rheumatology specialists was inadequate, and that the problem was related to lengthy waiting times for appointments rather than to difficulties in transportation. More patients with rheumatoid arthritis attended specialty clinics, but access to clinics and distance to clinics had no effect on clinic attendance by patients. Patients with poor access to rheumatology clinics were as likely to use assistive devices, and were as likely to be treated with steroids or other second line drugs. Accessibility to clinics was also not related to assessments of patients' disability levels. Disability levels were poorest in patients with rheumatoid arthritis. Larger studies may be needed to assess the effects of provision of rheumatological care. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Practice, Medical care, Rheumatic diseases, Medical care needs assessment, Rheumatology

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A concealed cause of recurrent renal failure in a patient with juvenile chronic arthritis

Article Abstract:

Recurrent kidney failure in a young man with juvenile chronic arthritis (JCA) was caused by the recreational drug ecstasy (MDMA). The man had repeated episodes of fever, low blood pressure, flu-like symptoms, and low urine output. Only after extensive diagnostic tests did he admit he had used ecstasy and amphetamine prior to each episode of illness. Ecstasy can cause dehydration and exacerbate kidney disease.

Scotland, Statistical Data Included, Causes of, Complications and side effects, Rheumatoid arthritis in children, Juvenile rheumatoid arthritis, Acute renal failure, Acute kidney failure, Ecstasy (Drug)

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