Easing the pain

Tanis Doering began having joint pain in the summer of 2008.

By October, the 48-year-old resident of Cypress County - 11 kilometres southeast of Medicine Hat - was barely able to get dressed or cook. She hoped the pain would just go away.

“My theory was that it came by itself, it will go away by itself, but it didn’t,” Doering says.

“It just kept getting worse and worse. I worked until I could barely walk anymore. My joints hurt. I couldn’t close my hands anymore. My shoulder hurt. Everything hurt.”

Doering soon learned she had rheumatoid arthritis, which causes chronic inflammation of the joints.

To support Albertans such as Doering, Alberta Health Services - in conjunction with the University of Calgary - launched rheumatology central triage at Foothills Medical Centre four years ago. 

The triage system has since helped about 20,000 central and southern Albertans be diagnosed and treated at specialized clinics and community practices.

Early treatment is critical to improving the long-term outcome for rheumatoid arthritis patients, says Dr. Dianne Mosher, chief of the Rheumatology Division at the U of C.

“It’s important to see these patients within three months to one year of their symptom onset. We know early intervention and treatment can change the course of their disease forever,” she says.

The triage system provides family doctors a single point of contact for rheumatology referrals. Triage nurses gather all of a patient’s background information in advance of appointments, maximizing both patient and physician time.

“The goal is to review the referrals within a few days of receiving them,” says Terri Lupton, a rheumatology triage nurse clinician.

Before the triage system launched in 2006, patients waited an average of 11 weeks to see a rheumatology specialist following a referral. Today, urgent patients are seen within 1.5 weeks; early inflammatory patients within 2.7 weeks.

Arthritis is the third most common chronic condition after allergy and back pain, affecting more than 400,000 Albertans (and 4.5 million Canadians) of all ages. It is also the leading cause of disability in the country. Symptoms include joint pain, swelling, stiffness and general fatigue, all of which can have a devastating impact on daily life.  Rheumatoid arthritis is just one of more than 100 different types of arthritis conditions.

Mosher says the number of Canadians with arthritis is expected to triple over the next 30 years. 

“We needed to find a way to best manage this population since it is so large and growing,” Mosher says. “The model has been successful because of the willingness of all rheumatologists to participate in central triage. We are the envy of not only other rheumatology divisions in this country but internationally.”

Doering was referred by her family physician to central triage in January 2009, and was seen and diagnosed with rheumatoid arthritis within two weeks. 
Medications help her manage the disease and have made a significant difference in her life.

“I can move better than I could,” Doering says. “My pain is better.”