Clinical economics: Rheumatoid arthritis

Rheumatoid arthritis is a systemic inflammatory disease. It is responsible for premature morbidity and disability. Its causes are unknown and there is no cure.

In addition to the financial burden associated with rheumatoid arthritis, patients suffer from reduced quality of life and increased disability. A self-reported survey found that patients with rheumatoid arthritis were 40% more likely to categorize their general health as “fair” or “poor” compared to patients without arthritis. These patients were also 30% more likely to require assistance with personal care and twice as likely to have limitations on their activities due to their health.

Patients with rheumatoid arthritis experience more losses in work, leisure, and social function. “Arthritis is a leading cause of disability,” says Stephen I. Katz, MD, PhD, director of the National Institute of Arthritis and Musculoskeletal and Skin Diseases. “With the aging of the population, it will increasingly burden individuals as well as the economy.”

Because of the chronic nature of rheumatoid arthritis management, and because patients may not have access to specialty rheumatology care, primary care physicians are challenged with the task of providing education, encouragement, and ongoing support to patients and their caregivers.

NEXT: Patient management tips

Patient Management Tips

Refer when possible, but be prepared to oversee care. Early diagnosis and treatment is important in patients with moderate to severe rheumatoid arthritis to help prevent damage, deformity, and subsequent disability.

A rheumatologist can not only help confirm the diagnosis, but also establish a treatment plan to maximize the benefits and minimize the risks of therapy. Rheumatologists understand the importance of early diagnosis and would expect to see patients with suspected rheumatoid arthritis expeditiously. A personal call from the referring family physician can be helpful in this regard.

In some cases, the current shortage of rheumatology professionals can result in prohibitive travel distances or long waiting periods for appointments. Therefore, primary care physicians should be prepared to act as the main care provider for patients with rheumatoid arthritis.

Whether or not a rheumatologist is available to be a part of patient’s care team, it can be helpful to build a network of additional appropriate healthcare providers.

Depending on the patient’s needs, these may include:

• nurse practitioners to aid in providing patient education,

• physical therapists to preserve strength and range of motion,

• occupational therapists to determine when assistive devices may be necessary,

• podiatrists to help treat arthritis in the foot or ankle, and

• ophthalmologists or optometrists to evaluate visual complications of rheumatoid arthritis

Optimizing communication. It is critical to coordinate effective communication among members of the patient care team, especially when providers from multiple specialties are involved. Physician-patient communication is equally important.

Patients with rheumatoid arthritis may be older and have trouble remembering subjects that they want to discuss during their appointments or directions given by their physician. Encourage them to make the most of office visits by bringing a list of their latest questions and a notebook for keeping track of instructions.

It may be appropriate to have a caregiver or family member join the patient during appointments to help facilitate communication. Inform patients of the best way to reach providers between visits and outside of office hours, including via phone and email.

Treating to target. As with many other chronic conditions, identifying one or more goals that are appropriate for an individual patient and regularly evaluating progress toward those goals based on measurable criteria are key.

Involving the patient and/or caregiver in goal-setting and treatment selection can help improve understanding, engagement, and adherence.

Supportive lifestyle changes. Rheumatoid arthritis can significantly impact patients’ sleep patterns and activities of daily living.

Recommending lifestyle changes, such as the use of assistive devices, regular exercise, a balanced diet, and good sleep hygiene may help provide supportive care and allow patients to manage symptoms. This is especially important because rheumatoid arthritis is associated with increased cardiovascular risk.

Therefore, clinicians should be cognizant of the potential need to also manage risk factors for heart disease in these patients.