Experts know that much of the damage caused by rheumatoid arthritis happens during the first two years of the disease. Unfortunately, during this critical period people sometimes avoid medical treatment in an effort to deny that something is wrong. The damage caused by untreated RA is permanent, however.

The necessity of early aggressive treatment is clearly illustrated by RA patient survey responses:

Eight out of ten RA patients say that their disease makes every aspect of daily life more difficult.

Seven out of ten feel that RA keeps them from living fully productive lives.

Eighty-one percent say they are frustrated because they no longer feel they are in control of their lives.

More than half say that RA keeps them from taking care of their families.

Now, early diagnosis and treatment can minimize the effects of RA and alter the course of the disease, improving patients' chances for a better quality of life than was possible in the past.

Those who are younger when the disease begins do better than those who are older at onset. Patients with the following risk factors tend fare worse than others, and should work closely with their physicians to monitor their disease:

Rheumatoid factor present in the blood

Family history of RA

More than 20 joints involved

Very high sed rate (erythrocyte sedimentation rate)

Rheumatoid nodules

Other concurrent diseases

Early x-ray evidence of bone, joint or cartilage erosion

Early disability or limitation in function

Systemic involvement such as vascular disease, pleurisy or pericarditis

Presence of the HLA-DR4 genes

One additional risk factor that every patient can modify is cigarette smoking. Smoking has been shown to significantly worsen the symptoms of RA. A study involving 336 patients revealed that those who were smokers or who had smoked in the past had higher levels of rheumatoid factor in their blood. They also had an increased risk for bone erosion. Patients who had smoked for 25 years or longer showed both rheumatoid factor and bone erosion that was three times greater than in people who did not smoke.

It is very important to develop a positive, open doctor-patient relationship that will facilitate excellent care. A good doctor-patient relationship is helpful in monitoring the patient for other problems that are associated with RA, sometimes resulting directly from the disease or the medications used to treat it. These include:

Anemia

Scleritis (inflammation of the eye)

Lung disease

Lymphoma and other cancers of the blood

Gastrointestinal problems

Osteoporosis (porous, brittle bones)

Infections

The best possible outcome of early treatment and good disease management is remission. Remission is defined as meeting at least five of these criteria for two consecutive months or longer:

1. Morning stiffness that lasts only 15 minutes or less

2. Absence of fatigue

3. Absence of joint pain

4. Absence of joint tenderness

5. Absence of swelling in joints or tendon sheaths

6. A sed rate of less than 30 mm per hour for women or 20 mm per hour for men

If complete remission cannot be achieved, the goals of treatment are slowing the rate of damage to the joints, maximizing function and alleviating pain. When these goals are met, patients can continue in their normal daily activities at home and at work and enjoy a good quality of life.

References

First published July 7, 2003
Copyright © 1999 Accordant Health Services, Inc. All Rights Reserved.

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