Children face year wait for arthritis care

CHILDREN with a potentially lifelong, crippling condition are waiting more than a year to see a specialist because of a shortage of resources.

Dr Orla Killeen, consultant paediatric rheumatologist at Our Lady’s Children’s Hospital in Crumlin, said between 150 and 200 children with juvenile idiopathic arthritis (JIA) are on a waiting list for 15-16 months awaiting a new appointment.

In addition, approximately 30 children regarded as urgent cases face a three to four-month wait.

The inpatient rehabilitation programme at Crumlin has also collapsed because of a lack of key members on its required multidisciplinary team.

The crisis in paediatric rheumatology has actually worsened since Dr Killeen advised the hospital one year ago that her service could no longer offer children with juvenile arthritis the full range of services necessary to treat their condition because of failure to fund core members of the specialist team.

Since then, the hospital’s inpatient rehabilitation programme has collapsed.

“Initially it was cut in half and then it was withdrawn altogether in the spring of last year. It was not possible to offer an effective service without a social worker, a psychologist and a podiatrist, which are key unfilled posts in our multi-disciplinary team. I would estimate that as a result, approximately 25 children aged nine to 15, who would have benefited last year from our unique inpatient rehabilitation, have had to instead rely on fragmented non-specialist, non-integrated, out-patient support which is typically already very oversubscribed,” Dr Killeen said.

Examples of the fallout from inadequate treatment include high rates of school absenteeism and a financial burden on parents left with no choice but to give up employment or request home tuition, Dr Killeen said. The debilitating condition can also lead to psycho-social issues for some children and early intervention was essential to address this, she said. Studies have shown depression is common in patients with arthritis, occurring in 13% to 42% of cases.

“Lack of early intervention reduces the chances of a good outcome. We know that early and aggressive treatment is associated with a better prognosis,” Dr Killeen said.

Another issue was the concentration of treatment in one centre and Dr Killeen said ideally, satellite clinics should be set up to treat those living outside of Dublin, but the resources simply weren’t there.

When left untreated, children with juvenile arthritis face permanent muscle wastage, joint damage and deformity and intense pain.

Arthritis Ireland described the growing waiting lists for paediatric rheumatology services as ‘unacceptable’.

“We continue to push the Government for investment in this area so we can reduce the delays in diagnosis that can result in long-term joint damage,” a spokesperson said.

The HSE said it had given a commitment for a second paediatric rheumatologist to be appointed to the Crumlin hospital.

“The post has been approved through the Consultant Appointment Committee and the recruitment process will commence shortly,” the HSE said.

Ireland has the second- lowest ratio of paediatric rheumatologists per head of population in Europe.

* For more information on juvenile arthritis log on to www.arthritisireland.ie/info/juvenileArthritis.php


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