Nearly 60 per cent of Ontario residents with rheumatoid arthritis aren't given quick access to a specialist, even though early treatment is critical, a new report finds.

Rheumatoid arthritis, or RA, is an autoimmune disease marked by inflammation of numerous joints and connective tissues. It differs from the more common form of arthritis, osteoarthritis, which usually develops in older age and is often due to "wear and tear" on specific joints.

RA can affect people of all ages, from toddlers to seniors, and women are twice as likely to be affected as men.

Once it's diagnosed, it's important for patients to see a specialist within three to six months, because, if left untreated, the disorder can lead to bone erosion, joint deformity and disability. They should then see specialists regularly to manage their condition.

"Unfortunately, only 42 per cent of women with rheumatoid arthritis in Ontario see specialists each year," Dr. Arlene Bierman, a physician at St. Michael's Hospital in Toronto and principal investigator of the study, said in a news release.

Bierman and her team from St. Mike's and the Institute for Clinical and Evaluative Sciences (ICES) found that younger women are less likely to see a specialist than women 45 or older. As well, they found that low-income women are less likely to have seen a specialist than those with higher incomes.

The team also found that a person's likelihood of seeing a specialist depends on where they live in the province, with many of those in remote communities waiting longer for care.

"Access to these services is important and there is much that can be done to improve this access through innovations in how we organize and deliver care for chronic disease," Bierman said.

The report is based on Ontario data, but undertreatment of rheumatoid arthritis is a problem across the country. That's in part because there are only about 350 arthritis specialists in all of Canada – and that figure includes those specialists who are strictly researchers and don't see patients.

Studies have shown that family doctors often fail to refer RA patients to specialists quickly.

Lynn Robinson knows that well. The 45-year-old says she failed to get an early diagnosis and treatment for her RA, which kept her off work and in severe pain for months.

"Each day, the pain became progressively worse until I couldn't dress myself, brush my teeth or even hold a pen," Robinson said in a news release from St. Michael's.

"I was off work and in excruciating pain. My doctor dismissed the idea that the symptoms could be arthritis until I finally pushed to see a specialist who confirmed my suspicion. Now, I'm on treatment and have been able to resume my daily activities, pain-free."

The study made other findings about care for other conditions that affect the bones, joints ligaments and tendons of Ontarians, including:

  • About 40 per cent of women and 35 per cent of men living with a musculoskeletal disease, including arthritis, also suffer from at least one other common chronic condition, such as diabetes or heart disease.
  • Women who have musculoskeletal disease have higher rates of disability than men with these conditions. Nearly 40 per cent of women and about 23 per cent of men living with musculoskeletal disease reported moderate to severe disability including limitations to their daily activities such as housework, laundry, grocery shopping, dressing, or washing.
  • Physical therapy is important to managing musculoskeletal conditions. But only 15 per cent of adults with these conditions reported seeing a physiotherapist at least once in the previous year.
  • Gaps in the care of osteoporosis also persist. Two thirds of men and women who required it after a fracture did not receive a bone mineral density test or medication to reduce the risk of a subsequent fracture.

The findings come from the latest chapter of the Project for an Ontario Women's Health Evidence-Based Report (POWER) study. The joint study between St. Michael's Hospital and ICES aims to provide a comprehensive overview of women's health in relation to gender, income, education, ethnicity and geography.

The study is being funded by Echo: Improving Women's Health in Ontario, an agency of the Ontario Ministry of Health and Long-Term Care.