10 October 2024
We are excited to announce the release of the sixth annual National Early Inflammatory Arthritis Audit (NEIAA) report, offering invaluable insights into the care for people aged 16 and above with early inflammatory arthritis (EIA). Covering the period from April 2023 to March 2024, this national report highlights the current state of rheumatology care across England and Wales, putting the spotlight on key areas for improvement and celebrating successes within the NHS.
Dr Liz Price, NEIAA Clinical Lead says:
“This is currently the only national oversight we have of compliance with quality standards in rheumatology. We know that timely review and early initiation of disease modifying drugs improves outcomes and reduces disability in rheumatoid arthritis, so it is vital we ensure that patients have rapid and equitable access to rheumatology services early in their disease course.”
The NEIAA remains a vital tool for assessing how rheumatology departments perform against NICE QS33. We’re proud to report that that all NHS trusts and health boards have participated in this year’s audit, a remarkable achievement considering the ongoing pressures on healthcare services. The audit allows clinicians and healthcare providers to identify gaps in care quality and continue improving services for people living with EIA, while working towards standardising care across different regions, trusts and diagnoses.
What’s new in this year’s report?
This year’s NEIAA report introduces three major updates that reflect the evolving focus on patient-centred care and timely treatment:
- Confirmed case inclusion: For the first time, only confirmed cases of eligible conditions are included in the audit, saving valuable admin time for NHS staff.
- Timeliness of treatment: The audit has shifted its focus to track the time from referral to the initiation of disease modifying antirheumatic drugs (DMARDs), instead of monitoring how quickly patients are seen by a rheumatologist. This change highlights the importance of starting effective treatment as early as possible to improve outcomes.
- Rare autoimmune rheumatic diseases (RAIRDs): Since September 2023, the NEIAA has been collecting benchmarking data for some rare autoimmune rheumatic diseases (RAIRDs), improving care standards for people living with these less common, yet serious, conditions.
Key findings from the report:
- Treatment timeliness for early inflammatory arthritis has improved since year three (June 2020 – March 2021).
- Remission rates remain stable at 35%, but there are still geographic variations.
- Many people living with EIA report that their symptoms have a substantial impact on their employment.
- Patient-reported mental health symptoms have increased, continuing a six-year trend.
- Waiting times for patients with rare autoimmune rheumatic diseases remain inconsistent.
Why the NEIAA report matters
The NEIAA is a crucial tool in shaping the future of inflammatory arthritis care, offering the data and insights need to drive meaningful change. The first three years of the audit showed promising improvements in treatment timeliness and remissions rates, but the pandemic set back some of this progress. While waiting times have improved post-pandemic, they still fall short of the standards set by NICE.
The findings from this report emphasise the strain on the NHS workforce, which currently lacks the capacity to consistently meet the recommended standard of care. These results offer us a unique opportunity to advocate for additional resources and systemic improvements that will benefit both patients and healthcare providers.
Our recommendations
We’ve outlined five key recommendations based on the report’s findings, which will be central to our ongoing advocacy and campaigning efforts:
- Ensure consultant job plan guidance includes allocated time for triage and pre-referral specialist advice.
- Ensure commissioned rheumatology services include protected EIA clinics.
- Produce a national guideline recommending that people living with EIA are offered a DMARD on the day of their diagnosis.
- Improve regulatory oversight of individual healthcare providers by utilising routine NEIAA data to assess standards of care and ensure compliance with quality standards.
- Improve timely access to employment and mental health support programmes for people living with EIA.
Spotlight on mental health
The publication of this year's NEIAA report coincides with World Mental Health Day, making it a fitting moment to reflect on the growing mental health challenges faced by people living with arthritis. This year’s data shows a continued rise in patient-reported mental health symptoms, such as anxiety and depression – an issue that is especially relevant in rheumatology.
Dr James Galloway explains:
"At a national level, we’ve seen a rise in mental health symptoms like anxiety and depression since the pandemic, and this is especially crucial in rheumatology. Research shows that patients with an existing mental health condition, like depression, have poorer treatment responses. Unless we address these mental health challenges in parallel with the rheumatic disease, treatment alone may not be enough. This year’s NEIAA report highlights the importance of ensuring rheumatology services are equipped to direct patients to appropriate mental health support.”
Explore the full report
We encourage all healthcare professionals, stakeholders, patients, and those involved or interested in rheumatology care to read the full NEIAA report here. Explore the findings of the NEIAA report to help us drive improvements in care and outcomes for people living with EIA.