Primary care for patients with rare chronic illnesses

What, if anything, is specific about having a rare disorder? Patients' judgements on being ill and being rare

BACKGROUND

Growing efforts are made to improve the situation of persons with rare diseases, but the specific nature of these disorders remains unclear.

OBJECTIVES

To establish (1) to what extent people with rare disorders think that their disease's rarity causes particular difficulties, (2) to what extent these difficulties relate to other causes than rarity (i.e. other characteristics of the disease or other components of the illness experience), (3) to what extent the rarity of the disease may relate to components of patients' experience other than those that are traditionally addressed (i.e. personal or daily life aspects).

METHODS

Semi-structured interviews with 29 patients and 15 parents of children with one of six rare diseases (cystic fibrosis, fragile X syndrome, Wilson's disease, mastocytosis, locked-in syndrome and a sixth syndrome). The interviews were conducted in France. The analysis draws on French pragmatic sociology and focuses on the participants' judgements of their experience. Findings The participants considered as normal and acceptable a range of situations that are often viewed as specific to rare disorders and unfair. This rather positive evaluation was conditional on some specific moral criteria being met. The participants attributed the cause of their difficulties to the failure of health professionals to meet these criteria. In the participants' experience, disease-related associations play a key role and rarity seems to contribute to making them especially important.

CONCLUSIONS

Patients' experience would be considerably improved if health professionals more often fulfilled their moral expectations, especially regarding diagnosis disclosure and information. (250 words).

Prevalence of zebras in general practice: data from the Continuous Morbidity Registration Nijmegen

OBJECTIVE

To explore the prevalence of rare diseases in the Continuous Morbidity Registration (CMR) Nijmegen, and to discuss methodological difficulties in the study of rare diseases in general practice.

METHODS

We selected all diseases with a prevalence <0.5/1000 patients/year between 1986 and 2006 in the CMR, and we compared the results with rare diseases in the Orphanet database of rare diseases.

RESULTS

We retrieved 71 codes of rare diseases: 15 referred to trauma or intoxications; the remaining 51 could be subdivided into malignancies, specific infections, diseases of short duration, and chronic diseases. Twenty (36%) of these 56 diseases were also listed in the Orphanet database (mostly malignancies and chronic diseases).

CONCLUSION

Although in the literature emphasis is placed on rare chronic diseases, the general practitioner is also confronted with many rare diseases of shorter duration. The CMR is not yet feasible for studying diseases with an extremely low prevalence.