1 in 5 patients with rheumatoid arthritis went undiagnosed during pandemic, study finds

The number of new diagnoses of rheumatoid arthritis fell by 20% in the first year of the COVID-19 pandemic, new research from a university in London has found. 

Researchers from King’s College London have found there could be a fifth of patients with rheumatoid arthritis that have gone undiagnosed, with cases not increasing above pre-pandemic levels. This suggests many of these patients have not been seen by their GP or been reviewed by a hospital specialist.  

Experts evaluated the diagnosis and treatment of different types of arthritis in England during the first two years of the pandemic.

If diagnosis and treatment is delayed, arthritis, which affects the joints, can lead to chronic disability due to joint damage, impaired function, work absence, and a reduced quality of life.

Early diagnosis and treatment of the condition improves outcomes for patients. Once diagnosed, patients can start highly effective treatments to control symptoms and prevent irreversible damage. 

Each year, the quality of care for people with rheumatoid arthritis is benchmarked through a process of national audit. These audits were paused during the pandemic, however, making comparisons of care challenging.

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

Results showed the number of newly recorded 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.

The study also showed the time it took for patients who were diagnosed with arthritis during the pandemic, to be admitted for an assessment by a hospital specialist was shorter than before 2020. 

However, for patients who were diagnosed during the pandemic, there did not appear to be more delays in starting treatment.

Additionally, researchers found the proportion of patients who were started on treatment was similar before and during COVID-19. However, medications were prescribed more frequently, which could relate to clinicians’ concerns about the effects of stronger medications on COVID-19 infections.

Lead author Dr Mark Russell, from King’s College London, said: ‘This study highlights that there are likely to be people with joint pain and swelling who remain undiagnosed as a consequence of the pandemic.

‘It is important to speak to a doctor if you have these symptoms, as early diagnosis and treatment of conditions such as rheumatoid arthritis greatly improves outcomes for patients and increases the likelihood of disease remission.

‘An important message of this study is that it is possible to assess the quality of care for patients with long-term health conditions using routinely collected health data. 

‘This approach could be applied to many other chronic health conditions and be used to provide feedback to NHS organisations and clinicians, with the aim of optimising care for patients.’

The study is published in The Lancet Rheumatology journal

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