Successes, challenges and developments in Australian rheumatology

Abstract

Australia is a geographically vast but sparsely populated country with many unique factors affecting the practice of rheumatology. With a population comprising minority Indigenous peoples, a historically European-origin majority population, and recent large-scale migration from Asia, the effect of ethnic diversity on the phenotype of rheumatic diseases such as systemic lupus erythematosus (SLE) is a constant of Australian rheumatology practice. Australia has a strong system of universal healthcare and subsidized access to medications, and clinical and research rheumatology are well developed, but inequitable access to specialist care in urban and regional centres, and the complex disconnected structure of the Australian healthcare system, can hinder the management of chronic diseases.

Association of MIF, but not type I interferon-induced chemokines, with increased disease activity in Asian patients with systemic lupus erythematosus

“…These findings are aligned with those of an earlier study from this centre 3 and with previous studies comparing SLE manifestations in separate Caucasian and Asian cohorts 22 . While some studies have highlighted economic and health system differences in contributing to divergent SLE outcomes in different regions 23 , the current study was undertaken in a single centre based in a public hospital in a universal healthcare setting 24 , consistent with a biological basis for the difference in disease severity in SLE patients of Asian, compared to non-Asian descent.…”

A patient‐centered knowledge translation tool for treat‐to‐target strategy in rheumatoid arthritis: Patient and rheumatologist perspectives

“…The logistical barriers of time and available appointments may speak to the local environment in Queensland and more broadly in Australia where there are only 0.014 rheumatologists per 1000 population. 28 Although this study was undertaken in an urban area, the lack of specialist rheumatology access is even more pronounced for patients living in regional areas of Australia.…”

The Asia‐Pacific Initiative for Rheumatology Nurse Education: Current gaps, programme development and future outlook

“…The imbalance in number of patients to rheumatologists means that patients are often managed by general practitioners lacking sufficient knowledge about disease and treatment, which may negatively impact proper diagnosis and management of patients (Louthrenoo, 2015). Furthermore, the concentration of rheumatologists in urban areas restrict the reach of specialist care to the rural population (Al Maini et al, 2015; Li, 2015; Morand & Leech, 2015). Long waiting times (Lim et al, 2015; Time to Move: Arthritis, 2014) and limited consultation time (Wang, Zou, Cong, & Liu, 2018) due to huge demand from patients (Lee et al, 2019) further exacerbates the issue of limited access to specialist care.…”

“…The treatment options for RDs have expanded substantially since the days of glucocorticoids and conventional synthetic disease‐modifying antirheumatic drugs (csDMARDs) with the advent of biologicals or biologic DMARDs (Romao & Fonseca, 2019). Biologics have been widely prescribed and closely monitored in several developed countries in Asia Pacific such as Japan, China, Korea (Kim & Song, 2016; Yamamoto, Song, & Li, 2018) and Australia (Morand & Leech, 2015). Besides the advent of novel treatment options, therapeutic strategy has been refined to improve disease management.…”