People with arthritis can have pain and difficulty moving around. It can cause loss of strength and grip, stiffness and tiredness. But these symptoms can generally be well managed.
For most people, arthritis is chronic. As yet, there is no cure for the condition but it can be managed successfully using a combination of medication, exercise, physiotherapy, and with the ongoing support of healthcare professionals.
The 2017/2018 priority issues for Arthritis New Zealand.
- Recognition and resourcing of arthritis as a health issue for government.
- Improving access to rheumatology services.
- Improving access to new medications.
- Early identification and treatment of gout especially for Māori and Pacific people.
- Accessible packaging and advocating for packaging and products to be designed with ease of use for people with arthritis and the elderly in mind.
We continue to maintain a watching brief on ACC - inparticular we are interested in the findings of the Miriam Dean report and of the development of a national advocacy service for clients of ACC
Why are these priority issues for us?
Access to rheumatology services
There is a shortage of rheumatologists in New Zealand. It takes at least seven years to train a rheumatologist and currently many of those that train in New Zealand leave and work abroad. The National Advisory Committee on Core Health and Disability Services suggested in 1994 there should be 1 full time rheumatologist for every 100,000 people. The British Society for Rheumatology suggests there should be 1 full time rheumatologist per 85,000 people. In many areas of New Zealand there are over 200,000 people to each available specialist.
Statistics on rheumatology provision collected in 2012 highlight the difference in provision across New Zealand, with some areas better served than others.
Many people have to travel far distances to see a rheumatologist. There may be changes in provision since these figures were published, however we believe that Manawatu is currently experiencing a shortage of rheumatologists.
A lack of specialists results in delays in being referred for appointment and therefore delays in receiving a diagnosis and treatment. Triaging of patients means some conditions such as fibromyalgia and osteoarthritis are unlikely to be seen by specialists across the whole of New Zealand.
The number of people with conditions such as arthritis is only going to grow. We need more specialist posts to match the need, both privately and publicly funded.
Are you having difficulty getting to see a rheumatologist? Let us know email firstname.lastname@example.org
Access to new medication
Pharmaceuticals play an important role in the treatment of all forms of arthritis. Medicines assist people with:
- Managing symptoms – particularly pain
- Preventing damage to joints
- Maintaining joint function
Inflammatory arthritis e.g. rheumatoid arthritis and ankylosing spondylitis (AS) in particular, can be treated using medications known as biologics. Advances in treatments for inflammatory arthritis such as juvenile idiopathic arthritis (JIA), rheumatoid arthritis (RA), ankylosing spondylitis (AS) and psoriatic arthritis (PsA) among others mean that it is realistic for people to achieve remission or a state of low disease activity.
The New Zealand Medicines Landscape Research published in 2017, revealed that patients in New Zealand were less likely to be able to access medications that are used around the world to treat arthritis. Only an estimated 3 percent of the total patient population receives treatment for arthritis with biologics, compared to around 9 to 10 percent in Australia and the United Kingdom.
Biological products include a wide range of products such as vaccines, blood and blood components, allergenics, somatic cells, gene therapy, tissues, and recombinant therapeutic proteins. Biological products often represent the cutting-edge of biomedical research and, in time, may offer the most effective means to treat a variety of medical illnesses and conditions that presently have no other treatments available.
Five biologic medications that are available in other countries cannot be accessed currently in New Zealand and six arthritis medications approved by the Pharmacology and Therapeutics Advisory Committee (PTAC) are currently waiting for funding. This includes tocilizumab (1 year 3 month wait from Feb 2017), Subcutaneous tocilizumab (1 year and a half wait from Feb 2017), Golimumab (6 years and 9 months wait from Feb 2017) and COX-2 inhibitors (2 and a half years wait time from Feb 2017).
Early treatment prevents ongoing and irreversible damage, improves patients’ quality of life, and saves the cost of hospital visits and lost work days. Not funding these medications also adds costs associated with benefit provision and an increased need for carer support.
Arthritis New Zealand works to advocate for the provision of better access to medications for the treatment of arthritis and believes this should be done through clearing the current Pharmacology and Therapeutics Advisory Committee (PTAC) waiting list and increased levels of funding for PHARMAC.
Have you had trouble accessing medications? Share your story with us here email@example.com
Early identification and treatment of gout
New Zealand has the highest per capita prevalence of gout in the world and gout is now the second most common form of arthritis in New Zealand. Approximately 160,000 people in New Zealand were diagnosed with gout in 2014. Gout is a form of inflammatory arthritis. Inflammation occurs in response to crystals of uric acid forming around the joints causing pain as a result of increased levels of uric acid in the blood, which can result in acute attacks. Levels of uric acid are mostly influenced by genetic factors however other contributing factors include weight and diet.
Māori and Pacific people, particularly men, have a higher genetic predisposition to developing gout, with at least twice the rate of gout compared to other ethnicities. Māori and Pacific island people are also five times more likely to be hospitalised for gout than other ethnicities.
Left untreated, gout can cause permanent damage to your joints, making joints painful and stiff to move. This can impact on people’s ability to work, take part in leisure or family activities. People with gout are also more likely to have diabetes and cardiovascular disease.
Gout is an easily managed form of arthritis – effective medications are already funded. A simple test can be used to measure uric acid levels in the blood and enable gout to be managed effectively with inexpensive medication. Better management of gout could be achieved with better awareness, screening and management in primary health care.
The Health Quality & Safety Commission Gout Atlas presents information on gout by specific district health board areas.
The ability to open packaging easily is an ongoing challenge for people with arthritis. We frequently have stories shared with us. It is clear that there are difficulties across a range of products and with different kinds of packaging. We know there are particular difficulties with tear open packaging, milk containers, medication and tight lids on jars.
For something to be accessible it must be easy to open and have legible labelling without compromising product safety, integrity or quality.
A survey by Catalyst Research found that in 2013, 53% of consumers have suffered an injury when trying to open packaging. Research in 2008 on requirements for packaging from an ageing consumer’s perspective recommended increasing the size of twist off caps, larger ring pulls on aluminium cans and including more sliding resealable closures on foil and plastic packaging.
As the population ages and arthritis becomes more prevalent, specific needs in relation to design and labelling of products will become even more important.
We encourage all businesses to develop products in conjunction with principles surrounding accessible design.
Is there a particular product you have trouble with? Please let us know (email firstname.lastname@example.org) being sure to tell us the company and specific product.
Musculoskeletal disorders (MSDs), such as arthritis, affect nearly 1 in 4 New Zealanders, adversely impacting the productivity and labour market participation of thousands of New Zealand workers. Research has shown that New Zealanders with arthritis are less likely to be employed than those without arthritis and many people with arthritis also have to move from full-time employment to part-time employment due to their arthritis, because of its impact on physical functioning (and psychological impacts due to pain). More than 50% of those with arthritis are of working age.
In September 2012 a new report, the Fit for Work Musculoskeletal Disorders and the New Zealand Labour Market, developed by The Work Foundation was released. This reveals that disability and chronic health conditions are two of the main obstacles to maintaining employment for millions of New Zealanders. Read the report.
Studies have demonstrated that workplace changes can reduce work disability from arthritis and can help to retain employment of those with arthritis. A supportive work environment such as those allowing adjusted flexible working hours, adjusted job demands, accessibility of workplaces and the presence of supportive co-workers and employers can all help to reduce withdrawal from the labour force by people with arthritis. Early clinical, policy and employment interventions can support job retention and a return to work.
Complete the survey on accesible packaging