RA treatment by regional medical liaison in an area with no rheumatologist

Abstract

  The treatment of rheumatoid arthritis（RA）has progressed dramatically. Early, adequate treatment of RA has greatly improved the quality of life and prognosis of patients. However, family doctors have difficulty treating RA because of the increasing frequency of complications of newer RA treatments, such as serious infections. Many RA patients cannot receive adequate treatment because there are too few rheumatologists. Hamada Medical Center（HMC）is located in a rural area in western Shimane Prefecture where one rheumatologist sees outpatients biweekly. Therefore, to treat RA outpatients, a regional medical liaison between family doctors and the HMC rheumatologist was introduced 10 years ago. The HMC rheumatologist takes charge of specialized tasks, such as diagnosis, evaluating organ function and latent infections, and the choice of disease-modifying anti-rheumatic drug（DMARD）. The regional family doctors adjust the DMARD dosage, ascertain its safety, and care for mild complications such as upper respiratory infections. The sharing of roles in treating RA between the rheumatologist and family doctors has enabled the rheumatologist to examine more RA patients in a limited time. Furthermore, fewer severe infections are treated in hospital with the liaison system than without it. The liaison has enabled an earlier diagnosis and safer treatment for 10 years.