Australians with arthritis are not getting the care they need, according to a report commissioned by Arthritis Australia. CEO of Arthritis Australia Ainslie Cahill said chronic, inflammatory forms of arthritis are a leading cause of disease burden and are also among the most common causes of disability and early retirement due to ill health in Australia. However there is a shortfall in rheumatology-dedicated nurses in Australia, with only one nurse to every 45,000 patients with the condition.

Osteoarthritis is the most common form of arthritis and the main non-inflammatory arthritis although evidence increasingly indicates inflammatory processes are a major contributor. It is a degenerative joint condition affecting almost 2.1 million Australians in 2014–15 (ABS 2015), projected to reach almost 2.5 million by 2020. Around 1.7 million Australians live with inflammatory forms of arthritis and related conditions. Most patients are cared for through primary care, however rheumatology nurses are commonly found in hospital outpatient units and in specialty private practice, caring for complex and advanced cases of arthritis. The report’s literature review found that 70% of osteoarthritis is considered preventable, and would at-risk patients would benefit from specialist care at the primary level by way of rheumatology nurses.

The report, Rheumatology Nurses: adding value to arthritis care, outlines the physical and financial cost arthritis presents to the country, highlighting how rheumatology nurses can decrease the average cost of treatment over four years per patient from $11,373 to $10,483 per person through their provision of faster diagnosis, care coordination, psychosocial and family support as well as condition and self-management education. By combining these functions into the one role, this reduces the need for patients to make visits to multiple clinicians and consolidates their care. It is noted however, that by providing this kind of care would present an increased cost to the government by up to $6.5 million. 

While arthritis during pregnancy can be a cause for concern, rheumatology nurses can liaise directly with obstetricians and midwives when managing rheumatology patients during pregnancy and the Australian Rheumatology Association (ARA) has prescribing guidelines for rheumatic diseases in pregnancy and during breast-feeding.

We spoke to Linda Bradbury, a rheumatology nurse with nearly 20 years’ experience and now working at the Princess Alexandra Hospital in Brisbane, who is keen to see more nurse practitioners enter the rheumatology specialty.

‘This role has been shown to work well overseas and in other chronic diseases in Australia.  I am the only NP credentialed at the moment but there are two more - one in Victoria and one in Hobart - that are coming up behind me which is exciting!’

Graduate Certificates in Musculoskeletal and Rheumatology Nursing, and similar postgraduate qualifications existed in Australia as recently as 2016, however specialist arthritis training is not currently available through universities – a reflection of the current support for the industry. For the time being, the weight of the training is falling upon already-skilled practitioners and researchers to mentor those who show an interest. Linda is confident anyone wanting to enter the field will find themselves in demand.

‘There is certainly a demand for fully-trained specialist rheumatology nurses, as can be seen by the figures in the report. The issue is getting funding to create new roles, persuading funders that this role is important and developing models of care for both the public and private sectors.’

Funding and staffing restrictions aside, Linda remains optimistic about the field and her patients.
‘It is very exciting times for patients with inflammatory arthritis with more treatment options available than ever before.  The role of the rheumatology nurse is becoming more and more important for these patients not only in an educational and support role for these sometimes complex medications that can have serious side effects but also with psychological support and advice about lifestyle choices.’
 
‘With the use of telephone help lines, we can be the first point of contact for advice, particularly useful for rural and remote areas, providing further information and escalating concerns to the rheumatologist as necessary.  I hope that with the results of this project, we can persuade stakeholders of the considerable value that rheumatology nurses can have in the care of the patient with inflammatory arthritis.’

‘There is a higher satisfaction from patients that see a nurse compared to those that don’t in all aspects of care! I find the other data very promising and alongside Arthritis Australia, I’m keen to move forward with how to achieve the next goals.’