Provision of medical and community services to people with severe arthritis; an audit

We have identified severely disabled arthritics who live in the community through social service records. All had either rheumatoid arthritis (RA) or osteoarthritis (OA). The diagnosis influenced referral to hospital, those with RA being referred while only half of those with OA had been referred. Referral was important for both surgical and environmental intervention. Provision of social services and community occupational therapy services was greater if the patients had been seen in hospital departments irrespective of the diagnosis. Recipients of joint surgery had all gained temporary benefit although progression of arthritis or other disabling disease compromised this after several years. There was a substantial minority of people with severe OA living in the community who had not been considered for joint replacement and did not have optimal provision of aids, appliances and environmental adaptation.