Arthritis patients still suffer as drugs guidelines are ignored

Jun 7 2005

Access to drugs whose use was approved by the UK's National Institute for Health and Clinical Excellence (NICE) three years ago is still being denied to patients with severe rheumatoid arthritis.

Although NICE was created to eliminate "postcode prescribing" it apparently has no power to force the NHS to implement its recommendations, which although the government has said are binding, does little to enforce them.

A survey by the British Society for Rheumatology of 148 rheumatology units, found that 31 per cent of doctors could not provide anti-TNF alpha drugs to all patients who qualified under NICE guidelines. The corresponding figure when the last survey was held in 2003 was 33 per cent, so there has been no improvement over the past two years.

The NICE guidelines are strict, and say that the drugs Etanercept and Infliximab should be given only to patients who have tried two other treatments unsuccessfully for at least six months, and only after referral to a specialist.

It is believed there are around 1,700 patients in Britain who cannot get access to the drugs, and the reason given by most units is a lack of money.

David Isenberg, the president of the British Society for Rheumatology, says doctors are very frustrated when they have patients who clearly qualify for anti-TNF intervention but are unable to get it.

He says these particular drugs offer hope and relief to people who have severe rheumatoid arthritis, and are likely to be affected by high levels of pain and disability, which makes daily living very difficult.

Doctors also say that they are unable to access drugs which help people with other arthritis-related conditions despite the clear benefits of doing so: 58 per cent were unable to prescribe the treatments for people with ankylosing spondylitis, and 53 per cent said that they were unable to prescribe the treatments for people with psoriatic arthritis. NICE is currently developing guidance on these treatments, but, meanwhile the lack of approval from NICE is the main barrier to treatment.

Professor Isenberg says although NICE guidance was developed to combat this type of inequality, it does not work for all patients, and it is wrong that some people are being left with unnecessary pain and disability.

Isenberg says the Department of Health should remind health trusts that they need to take urgent action to ensure people get the treatment they are entitled to.