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.
This is a preview of subscription content, access via your institution
Relevant articles
Open Access articles citing this article.
-
Association of MIF, but not type I interferon-induced chemokines, with increased disease activity in Asian patients with systemic lupus erythematosus
Scientific Reports Open Access 25 July 2016
Access options
Subscribe to this journal
Receive 12 print issues and online access
$209.00 per year
only $17.42 per issue
Buy this article
- Purchase on Springer Link
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
References
Beach, W. G. The Australian Federal constitution. Polit. Sci. Q. 14, 663–680 (1899).
Selway, B. & Williams, J. M. The High Court and Australian Federalism. Publius 35, 467–488 (2005).
Willis, E., Reynolds, L. & Keleher, H. (Ed.) Understanding the Australian Health Care System (Elsevier Health Sciences, 2009).
OECD. Health at a glance–OECD indicators [online], (2013).
Zhang, M., Holman, C. D., Preen, D. B. & Brameld, K. Repeat adverse drug reactions causing hospitalization in older Australians: a population-based longitudinal study 1980–2003. Br. J. Clin. Pharmacol. 63, 163–170 (2007).
Lehnbom, E. C., McLachlan, A. & Brien, J. A. A qualitative study of Australians' opinions about personally controlled electronic health records. Stud. Health Technol. Inform. 178, 105–110 (2012).
Henry, D. A., Hill, S. R. & Harris, A. Drug prices and value for money: the Australian Pharmaceutical Benefits Scheme. JAMA 294, 2630–2632 (2005).
Drummond, M., Jonsson, B. & Rutten, F. The role of economic evaluation in the pricing and reimbursement of medicines. Health Policy 40, 199–215 (1997).
Morgan, S. G. et al. Centralized drug review processes in Australia, Canada, New Zealand, and the United Kingdom. Health Aff. (Millwood) 25, 337–347 (2006).
Bloor, K., Maynard, A. & Freemantle, N. Lessons from international experience in controlling pharmaceutical expenditure. III: regulating industry. BMJ 313, 33–35 (1996).
Duckett, S., Breadon, P., Ginnivan, L. & Nolan, J. Poor pricing progress: price disclosure isn't the answer to high drug prices. Grattan Institute website [online], (2013).
Deal, C. L. et al. The United States rheumatology workforce: supply and demand, 2005–2025 Arthritis Rheum. 56, 722–729 (2007).
Deal, C. L. The regional distribution of rheumatologists: what can we do, what should we do? Arthritis Rheum. 65, 3011–3013 (2013).
Arthritis Victoria. Arthritis Map: Victorian musculoskeletal community directory [online] (2015).
Chondur, R., Li, S. Q., Guthridge, S. & Lawton, P. Does relative remoteness affect chronic disease outcomes? Geographic variation in chronic disease mortality in Australia, 2002–2006. Aust. N. Z. J. Public Health 38, 117–121 (2014).
Zhang, F. The China rheumatology workforce: a status report. Int. J. Rheum. Dis. 12, 279–282 (2009).
Jakes, R. W. et al. Systematic review of the epidemiology of systemic lupus erythematosus in the Asia-Pacific region: prevalence, incidence, clinical features, and mortality. Arthritis Care Res. (Hoboken) 64, 159–168 (2012).
Freemantle, J. et al. Indigenous mortality (revealed): The Invisible illuminated. Am. J. Public Health, e1–e9 (2014).
Gao, X. & Serjeantson, S. W. Diversity in HLA-DR4-related, DR, DQ haplotypes in Australia, Oceania, and China. Hum. Immunol. 32, 269–276 (1991).
Roberts-Thomson, K. F. et al. Prevalence, extent and severity of severe periodontal destruction in an urban Aboriginal and Torres Strait Islander population. Aust. Dent. J. 59, 43–47 (2014).
Khan, M. A. HLA-B27 and its subtypes in world populations. Curr. Opin. Rheum. 7, 263–269 (1995).
Roberts-Thomson, R. A. & Roberts-Thomson, P. J. Rheumatic disease and the Australian aborigine. Ann. Rheum. Dis. 58, 266–270 (1999).
Chang, J. H., Raju, R., Henderson, T. R. & McCluskey, P. J. Incidence and pattern of acute anterior uveitis in Central Australia. Br. J. Ophthalmol. 94, 154–156 (2010).
Vincent, F. B., Bourke, P., Morand, E. F., Mackay, F. & Bossingham, D. Focus on systemic lupus erythematosus in Indigenous Australians: towards a better understanding of autoimmune diseases. Intern. Med. J. 43, 227–234 (2013).
Anstey, N. M., Bastian, I., Dunckley, H. & Currie, B. J. Systemic lupus erythematosus in Australian aborigines: high prevalence, morbidity and mortality. Aust. N. Z. J. Med. 23, 646–651 (1993).
Bossingham, D. Systemic lupus erythematosus in the far north of Queensland. Lupus 12, 327–331 (2003).
Grennan, D. M. & Bossingham, D. Systemic lupus erythematosus (SLE): different prevalences in different populations of Australian aboriginals. Aust. N. Z. J. Med. 25, 182–183 (1995).
Segasothy, M. & Phillips, P. A. Systemic lupus erythematosus in Aborigines and Caucasians in central Australia: a comparative study. Lupus 10, 439–444 (2001).
Bloor, G., Rigby, R. J., Richmond, J. M., Zilko, P. J. & Dawkins, R. L. Systemic lupus erythematosus in Australian Aborigines. Aust. N. Z. J. Med. 12, 553 (1982).
Stewart, J. H., McCredie, M. R. & McDonald, S. P. The incidence of treated end-stage renal disease in New Zealand Maori and Pacific Island people and in Indigenous Australians. Nephrol. Dial. Transplant. 19, 678–685 (2004).
Ranford, P., Hay, J., Serjeantson, S. W. & Dunckley, H. A high frequency of inherited deficiency of complement component C4 in Darwin Aborigines. Aust. N. Z. J. Med. 17, 420–423 (1987).
Anstey, N. M., Bastian, I., Dunckley, H. & Currie, B. J. Systemic lupus erythematosus (SLE): different prevalences in different populations of Australian aborigines. Aust. N. Z. J. Med. 25, 736 (1995).
Connelly, K., Morand, E. F. & Hoi, A. Y. Asian ethnicity in systemic lupus erythematosus: an Australian perspective. Intern. Med. J. 43, 618–624 (2013).
Golder, V., Connelly, K., Staples, M., Morand, E. & Hoi, A. Association of Asian ethnicity with disease activity in SLE: an observational study from the Monash Lupus Clinic. Lupus 22, 1425–1430 (2013).
The Times. The World University Rankings [online], http://www.timeshighereducation.co.uk/world-university-rankings/2014-15/world-ranking (2014).
Scally, S. W. et al. A molecular basis for the association of the HLA-DRB1 locus, citrullination, and rheumatoid arthritis. J. Exp. Med. 210, 2569–2582 (2013).
Vincent, F. B., Morand, E. F., Schneider, P. & Mackay, F. The BAFF/APRIL system in SLE pathogenesis. Nat. Rev. Rheumatol. 10, 365–373 (2014).
Wellcome Trust Case Control Consortium et al. Association scan of 14,500 nonsynonymous SNPs in four diseases identifies autoimmunity variants. Nat. Genet. 39, 1329–1337 (2007).
Cornish, A. L., Campbell, I. K., McKenzie, B. S., Chatfield, S. & Wicks, I. P. G-CSF and GM-CSF as therapeutic targets in rheumatoid arthritis. Nat. Rev. Rheumatol. 5, 554–559 (2009).
Ayoub, S., Hickey, M. J. & Morand, E. F. Mechanisms of disease: macrophage migration inhibitory factor in SLE, RA and atherosclerosis. Nat. Clin. Pract. Rheumatol. 4, 98–105 (2008).
Hoi, A. Y. et al. Macrophage migration inhibitory factor deficiency attenuates macrophage recruitment, glomerulonephritis, and lethality in MRL/lpr mice. J. Immunol. 177, 5687–5696 (2006).
Buchbinder, R. et al. A randomized trial of vertebroplasty for painful osteoporotic vertebral fractures. N. Engl. J. Med. 361, 557–568 (2009).
Jones, G. et al. Comparison of tocilizumab monotherapy versus methotrexate monotherapy in patients with moderate to severe rheumatoid arthritis: the AMBITION study. Ann. Rheum. Dis. 69, 88–96 (2010).
Teichtahl, A. J. et al. Weight change and change in tibial cartilage volume and symptoms in obese adults. Ann. Rheum. Dis. http://dx.doi.org/10.1136/annrheumdis-2013-204488.
Ebeling, P. R. et al. Effects of calcitriol or calcium on bone mineral density, bone turnover, and fractures in men with primary osteoporosis: a two-year randomized, double blind, double placebo study. J. Clin. Endocrinol. Metab. 86, 4098–4103 (2001).
Osthoff, M. et al. Potential role of the lectin pathway of complement in the pathogenesis and disease manifestations of systemic sclerosis: a case inverted question markcontrol and cohort study. Arthritis Res. Ther. 16, 480 (2014).
Morrisroe, K. B. et al. The association of antiphospholipid antibodies with cardiopulmonary manifestations of systemic sclerosis. Clin. Exp. Rheumatol. 32 (6 Suppl. 86) S133–S137 (2014).
Thakkar, V., Stevens, W. M., Moore, O. A. & Nikpour, M. Performance of screening algorithms in systemic sclerosis-related pulmonary arterial hypertension: a systematic review. Intern. Med. J. 43, 751–760 (2013).
Franklyn, K., Hoi, A., Nikpour, M. & Morand, E. F. The need to define treatment goals for systemic lupus erythematosus. Nat. Rev. Rheumatol. 10, 567–571 (2014).
Morand, E. F. et al. Consensus definition and preliminary validation of a low disease activity state in systemic lupus erythematosus. Arthritis and Rheum. 65, S664–S665 (2013).
Zborovski, S., Rohekar, G. & Rohekar, S. Strategies to improve recruitment into rheumatology: results of the Workforce in Rheumatology Issues Study (WRIST). J. Rheumatol 37, 1749–1755 (2010).
Rahbar, L. et al. Correlation of rheumatology subspecialty choice and identifiable strong motivations, including intellectual interest. Arthritis Care Res. (Hoboken) 62, 1796–1804 (2010).
McDonald, F. S., West, C. P., Popkave, C. & Kolars, J. C. Educational debt and reported career plans among internal medicine residents. Ann. Intern. Med. 149, 416–420 (2008).
Frintner, M. P., Mulvey, H. J., Pletcher, B. A. & Olson, L. M. Pediatric resident debt and career intentions. Pediatrics 131, 312–318 (2013).
Alarcon, G. S. & Amigo, M. C. The impact of women in the practice of academic and clinical rheumatology in the Americas. J. Rheumatol. 27, 1827–1829 (2000).
Hordern, A. et al. Use of an electronic drug monitoring system for ambulatory patients with chronic disease: how does it impact on nurses' time spent documenting clinical care? Stud. Health Technol. Inform. 178, 71–76 (2012).
Bourne, A. M., Whittle, S. L., Richards, B. L., Maher, C. G. & Buchbinder, R. The scope, funding and publication of musculoskeletal clinical trials performed in Australia. Med. J. Aust. 200, 88–91 (2014).
Herbert, D. L., Barnett, A. G. & Graves, N. Funding: Australia's grant system wastes time. Nature 495, 314 (2013).
National Health and Medical Research Council of Australia. Outcome of funding rounds [online], (2014).
Morgan, B. Australia reworks research philanthropy to fill unmet need. Nat. Med. 16, 730 (2010).
Arthritis Research Council UK. Annual report and financial statements [online], (2014).
Arthritis Australia. A year in review 2013–2014 [online], (2014).
Yedidia, M. J. & Bickel, J. Why aren't there more women leaders in academic medicine? The views of clinical department chairs. Acad. Med. 76, 453–465 (2001).
Office of the Chief Scientist, Commonwealth of Australia. Benchmarking Australian science, technology, engineering and mathematics [online], (2014).
Tymms, K. et al. Barriers to optimal disease control for rheumatoid arthritis patients with moderate and high disease activity. Arthritis Care Res. (Hoboken) 66, 190–196 (2014).
Littlejohn, G. et al. A multi-center, observational study shows high proportion of Australian rheumatoid arthritis patients have inadequate disease control. Int. J. Rheum. Dis. 16, 532–538 (2013).
Bird, P. et al. The SMILE study safety of methotrexate in combination with leflunomide in rheumatoid arthritis. J. Rheumatol. 40, 228–235 (2013).
Curran, V. & Rourke, J. The role of medical education in the recruitment and retention of rural physicians. Med. Teach. 26, 265–272 (2004).
Gruen, R. L., Weeramanthri, T. S. & Bailie, R. S. Outreach and improved access to specialist services for indigenous people in remote Australia: the requirements for sustainability. J. Epidemiol. Community Health 56, 517–521 (2002).
Moffatt, J. J. & Eley, D. S. Barriers to the up-take of telemedicine in Australia-a view from providers. Rural Remote Health 11, 1581 (2011).
Moffatt, J. J. & Eley, D. S. The reported benefits of telehealth for rural Australians. Aust. Health Rev. 34, 276–281 (2010).
Acknowledgements
The opinions expressed in this article are ours, and do not necessarily reflect the views of the Asia–Pacific League of Associations for Rheumatology (APLAR), the Australian Rheumatology Association (ARA), the International League of Associations for Rheumatology (ILAR) or the Australian government.
Author information
Authors and Affiliations
Contributions
E.F.M. researched data for the article. Both authors contributed to discussion of content, writing and review/editing of the manuscript before submission.
Corresponding author
Ethics declarations
Competing interests
The authors declare no competing financial interests.
Rights and permissions
About this article
Cite this article
Morand, E., Leech, M. Successes, challenges and developments in Australian rheumatology. Nat Rev Rheumatol 11, 430–436 (2015). https://doi.org/10.1038/nrrheum.2015.22
Published:
Issue Date:
DOI: https://doi.org/10.1038/nrrheum.2015.22