In RA the body's immune system attacks the joints
Tens of thousands of patients with rheumatoid arthritis (RA) are not being diagnosed or treated quickly enough, says a watchdog.
The National Audit Office says over half a million people in England live with the disease, with 26,000 new cases a year - double the current estimate.
But only a tenth are treated within three months of symptoms starting, as ideally they should be.
This is because many delay seeing a GP, and RA is difficult to diagnose.
Professor Alan Silman, medical director of the Arthritis Research Campaign, said the report painted an "unsurprising but depressingly gloomy picture of the state of current patient care".
Early diagnosis and treatment is key to minimising the damage and disability caused by this progressive and incurable joint disease.
But people rarely associate RA symptoms - painful, swollen or stiff joints - with a condition needing prompt medical attention.
According to the NAO, up to three quarters of people with RA delay seeing their GP beyond the recommended three months for treatment.
Even if they do seek help, on average patients see their GP four times before being referred for treatment by a specialist, by which time irreversible damage to the joints may have occurred.
A fifth have to see their GP eight or more times to get a treatment referral.
The average length of time from the onset of symptoms to treatment is nine months, and this has not improved in the past five years.
Only 10% of people with the disease are treated within three months of first noticing symptoms.
If this could be doubled to 20% of patients, says the NAO, at a cost to the NHS of £11m over five years, it would ultimately save the NHS money and could mean productivity gains of £31m for the economy due to reduced sick leave and lost employment.
RA is most common after the age of 40 but can affect any age
Women are more than twice as likely as men to have RA
Severe RA can shorten life expectancy by between six and 10 years
Currently, RA costs the NHS around half a billion in healthcare costs and the economy £1.8 billion a year in sick leave and work-related disability.
Over a third of people with RA will have stopped working within two years of disease onset.
The report recommends government consider a public awareness campaign to encourage more people with RA to seek help early, as well as more training for GPs to better recognise the symptoms and the need to refer suspected cases promptly.
It also flags up a need for services to help people with RA remain in work.
Edward Leigh MP, chairman of the Committee of Public Accounts that will now consider the report and make recommendations to the Department of Health, said the NHS needed to get better at spotting people with RA and providing prompt treatment.
"The NHS should also make sure that there are appropriate support services following diagnosis, including support to help people manage this disease themselves and to remain in work," he said.
Health minister Ann Keen said the government's policy for caring for patients with long-term conditions - such as RA - supported the recommendations made by the NAO.
Neil Betteridge of Arthritis Care urged health chiefs to implement its recommendations as swiftly as possible.
He said: "Early diagnosis and referral for suitable treatment is crucial as it can stop this debilitating condition in its tracks."
The National Rheumatoid Arthritis Society backed the call for a public awareness campaign.