Thursday 24 April, 2014

Rheumatoid arthritis can lead to unemployment and early death

Published On: Mon, Jul 2nd, 2012 | Rheumatology | By BioNews

When it comes to deadly and disabling diseases, most media appear to pay attention to conditions such as cancer and Alzheimer’s.

But Mayo Clinic researchers say there are others that take a similarly high toll, and rheumatoid arthritis is one of them.

It is a common cause of disability: 1 of every 5 rheumatoid arthritis patients is unable to work two years after diagnosis, and within five years, that rises to one-third. Life expectancy drops by up to five years, they said.

Rheumatoid arthritis patients also have a 50 percent higher risk of heart attack and twice the danger of heart failure, they pointed out.

Much progress has been made in recognizing the importance of early diagnosis and prompt and aggressive treatment, but gaps in understanding of the disease remain, according to study authors, Mayo Clinic rheumatologists John Davis III, M.D., and Eric Matteson, M.D.

“There are many drug therapies available now for management of rheumatoid arthritis, but the challenge for patients and their physicians is to decide on the best approach for initial management and then subsequent treatment modification based on the response,” said Dr. Davis.

“In our article, we reveal our approach including algorithms for managing the disease that we believe will enhance the probability that patients will achieve remission, improved physical function, and optimal quality of life,” he noted.

In rheumatoid arthritis, the immune system assaults tissue, causing swollen and tender joints and sometimes involving other organs. The top goal of treatment is to achieve remission, controlling the underlying inflammation, easing pain, improving quality of life and preserving patients’ independence and ability to work and enjoy other pursuits. Long-term goals include preventing joint destruction and other complications such as heart disease and osteoporosis.

Dr. Davis and Dr. Matteson offer several tips and observations:

“It is very important to have rheumatoid arthritis properly diagnosed, and treatment started early on. Getting the disease under control leads to better outcomes for the patient, ability to continue working and taking care of one’s self, less need for joint replacement surgery, and reduced risk of heart disease,” said Dr. Matteson.

More than medication is needed to best manage rheumatoid arthritis. Educating patients about how to protect their joints and the importance of rest and offering them orthotics, splints and other helpful devices can substantially reduce pain and improve their ability to function.

Cognitive behavioural therapy can make patients feel less helpless. Exercise programs that include aerobic exercise and strength training help achieve a leaner body; even modest weight loss can significantly reduce the burden on joints.

“Our management approach is informed by current evidence and our clinical experience. We believe it is crucial that patients and their doctors thoroughly discuss the treatment options and decide on the management plan jointly in view of individual patient preferences, goals and values,” Dr. Davis said.

The researchers reported their finding in the July issue of Mayo Clinic Proceedings in an article taking stock of current diagnosis and treatment approaches.

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