Why I treat Rheumatoid Arthritis aggressively

By Irwin Lim, Rheumatologist

Up to 20% of patients with Rheumatoid Arthritis (RA) have a relatively good prognosis, with occasional flares and low level disease.

However, the majority with RA have progressive disease. This leads to joint destruction.

Destruction then deformity lead to suffering.

The reasons I and most other rheumatologists would treat rheumatoid arthritis aggressively (in the appropriate patient) is because rheumatoid arthritis is a ‘bad’ disease:

1) Patients with RA have a 1 in 3 chance of becoming disabled

2) Disability starts early:

1. Within 1 year, 7.5% of patients will be unable to work at full capacity
2. Within 10 years, 27% of RA patients were work disabled.

3) Mortality (death) is increased 2-fold for RA patients.

4) Mortality associated with RA is similar to that of diabetes. This risk of premature death is linked to the severity of RA.

5) RA is associated with a shortening of life expectancy by 7-10 years.

6) Patients with RA have an increased risk of developing other serious conditions, including:

1. Infections, particularly lung, skin & joint infections;
2. Lymphomas;
3. Cardiovascular disease.

Given patients with uncontrolled disease do worse, our treatment strategies for rheumatoid arthritis now recognise that early therapy is critical.

Even a delay of as little as a few months in the introduction of disease-modifying anti-rheumatic drugs (DMARDs) following diagnosis can result in substantially more joint damage compared with early treatment.

Current thinking would suggest a strategy of intensive treatment. This includes:

1) Education for patients, about the disease & the therapies involved;

2) Early institution of DMARD therapy, with the 1^st line choice usually Methotrexate;

3) The escalation of DMARD therapy from a single agent to triple therapy or alternative agents, including biologic DMARDs where required;

4) More frequent assessment of patients, utilizing objective disease measures where possible;

5) Tight control of disease is the goal;

6) Multidisciplinary care utilizing a rheumatology educator/nurse, physiotherapists, hand therapists, etc when required. These are elements of our Connected Care approach.

Rheumatologists are the specialty group with expertise in treating rheumatoid arthritis.

Early referral to a rheumatologist for early diagnosis, and appropriate DMARD therapy, are the cornerstones of successful treatment of RA.

Is this how your rheumatoid arthritis is being treated?