Litigation trends within rheumatology: a retrospective analysis of litigation claims data from England for the Getting It Right First Time programme

Objectives To examine rheumatology-related litigation claims over a five-year period to describe trends and identify learning opportunities. Methods Data were extracted from NHS Resolution for all claims within rheumatology or referencing “giant cell arteritis” (GCA) or “vasculitis” within any specialty, over five years (2018/19-2022/23). Variables for each claim included cause, injury, costs, and claim status. Results We identified 152 rheumatology claims (total cost £28.2 million). The most frequent injuries were unnecessary pain (n = 70, 46%), fatality (n = 14, 9%), and psychiatric/psychological damage (n = 13, 9%). Where specified, 37 claims (24%) involved inflammatory arthritis, and 22 (14%) related to rare autoimmune rheumatic diseases (RAIRDs), such as vasculitis. Only 23 of the 152 claims were closed by the end of the study period, with just four being settled in favour of the claimant. Of these four, three involved soft tissue steroid injections. All 14 fatality cases with specified underlying conditions were RAIRDs. Diagnostic issues accounted for 38% of claims, treatment issues for 30%. Six claims exceeded £1 million. Forty-four GCA-related claims (total cost £13.1 million) were identified, mostly in ophthalmology or emergency medicine, rather than rheumatology, representing a doubling compared to the previous 5-year period. Sixteen vasculitis-related claims (£3.4 million) were identified. Conclusion High-cost, high-harm claims persist in rheumatology, with most remaining open for several years, creating personal, financial and professional strain. GCA-related claims occurs mostly outside rheumatology, highlighting the need for pan-speciality awareness agreed care pathways. RAIRD-related seemed over-represented in cases of fatality, highlighting the importance of timely suspicion, close monitoring, and careful management.