English version - Fit for Work Europe

5.4
Recommendations
for health care
professionals
MSDs and health care professionals
and its consequences. In one survey 50 per cent of individuals living with RA reported
improvement in the rate of turnover and absence, given tight control of their condition (Japan
Rheumatoid Arthritis Friendship Association, 2010). Effective management of RA has to involve
not only the clinical team (including consultant rheumatologists, physiotherapists, chiropodists,
podiatrists, pharmacists, primary care nurses and orthopaedic surgeons), but the participation of
the patient and, ideally, their employers. Social workers also have a role to play.
Rehabilitation accounts for just 1 per cent of medical costs of RA. A survey of 8,307 RA
patients by the Rheumatoid Arthritis Friendship Association showed that only 27.7 per cent
of patients were undergoing rehabilitation. At least 41.4 per cent said that they had not
undertaken rehabilitation because it had never been suggested to them by their physician,
while a further 14.7 per cent said a suitable rehabilitation specialist was not available (Japan
Rheumatoid Arthritis Friendship Association, 2010). This again reinforces the need for increased
communication between specialist physicians and other health care professionals, and the
importance of a team medical system.
5.3.3 Spondyloarthropathies
Prompt referral to specialists for confirmation of diagnosis and the start of treatment is also
essential for those with SpA and other rheumatic conditions. Since (similarly to RA) there is
no cure for SpA, the aim of therapeutic intervention is to reduce inflammation, control pain
and stiffness, alleviate systemic symptoms such as fatigue, and to slow or stop the long-term
progression of the disease. Anti-TNF drug therapy is now commonly used in the treatment of
SpAs in Japan. In addition, standard treatment also includes non-steroidal anti-inflammatory
drugs as well as patient education, physical therapy, and self-management with exercise and
relief of pain and stiffness (Stafford and Youssef, 2002).
As SpA typically affects relatively young people, its potential to disrupt or even curtail an
individual’s labour market participation may be significant. As discussed, there are important
clinical, social and economic benefits to keeping these patients in work as long and as
consistently as possible. Depending on the severity of their condition, AS patients may
benefit from workplace adjustments, flexible working arrangements, exercise regimes and
physiotherapy (Boonen et al., 2001).
Prompt referral to the appropriate specialist, and a timely intervention are key to achieving the
most effective outcomes of treatment of MSD patients. Individuals with MSDs can experience
numerous problems associated with long-term care, including long waits, failure to undertake a
multidisciplinary approach to treatment, poor advice on pain management, and a lack of clear
integrated pathways. It is important that health care is planned in partnership with the employers
Fit For Work? Musculoskeletal Disorders and the Japanese Labour Market 47