Counseling Points - October 2007 - (Page 4)

Introduction Rheumatic diseases are characterized by inflammation and loss of function of one or more connecting or supporting structures of the body.1 These disorders affect joints, tendons, ligaments, bones, and muscles. Common symptoms are pain, swelling, and stiffness. Some rheumatic disorders also may affect internal organs. Rheumatoid arthritis (RA) is one of more than 100 known rheumatic diseases.1 It is also an autoimmune disease.2 Autoimmune disorders are conditions that occur when the immune system mistakenly attacks and destroys healthy body tissue. Organs and tissues commonly affected by these types of diseases include red blood cells, blood vessels, muscles, connective tissues, endocrine glands, joints, and skin. Along with RA, there are more than 80 different types of autoimmune disorders including diseases such as multiple sclerosis, lupus, and type 1 diabetes.2 Figure 1. Deformity in Rheumatoid Arthritis ©Bart’s Medical Library/Phototake Overview of RA RA is a chronic, systemic, inflammatory and destructive disorder that is associated with significant mortality, functional disability, and economic burden. It can afflict many tissues throughout the body, but the synovial membrane of diarthrodial joints is usually most severely affected.1 A definitive cause of the disease has yet to be identified.1,3 It is characterized by symmetric polyarthritis, which is often erosive, that results in loss of joint integrity and irreversible damage.1,3 Left untreated, the disease may lead to substantial disability, deformity, and premature death (Figure 1). In fact, without treatment, 20% to 30% of individuals with RA become permanently work-disabled within 2 to 3 years of diagnosis.1 Although the musculoskeletal manifestations usually dominate the clinical picture of RA, extra-articular manifestations that affect a variety of organs are also common and, on rare occasions, can be life threatening.1,4 Some examples of extra-articular manifestations that patients may experience include vasculitis, anemia, keratoconjunctivitis, rheumatoid nodules, and pulCOUNSELING POINTS™ 4 monary and cardiovascular complications, such as emphysema and cardiomyopathy.1,4 Spontaneous remission is rare and RA typically progresses to a chronic, disabling state. Patients with RA have disability rates four to 15 times higher than those of the general population. 5 After having the disease for 10 years, up to 50% of patients will be disabled, and after 20 years, 80% or more of individuals with RA will have some disability or deformity.6 RA is the most common immune-mediated inflammatory arthropathy, and affects an estimated 1% of the population worldwide.3 Prevalence of RA increases with age and 80% of patients develop the disease between the ages of 35 and 50.1,3 Females are disproportionately afflicted with the condition—it occurs three times more frequently in women than in men.1 RA is apparent in nearly all ethnic groups; however, in specific populations, such as certain native American Indian tribes, the prevalence of the disease may be as high as 7%.1 Conversely, African and Asian populations are the least affected by the disease with a prevalence typically of less than 1%.1 RA Morbidity and Mortality Patients with RA have an approximately 29% higher rate of mortality than those who do not have the condition and the disease has been related to a 5- to 18-

Table of Contents Feed for the Digital Edition of Counseling Points - October 2007

Counseling Points - October 2007 Welcome Introduction Overview of RA RA Morbidity and Mortality RA Costs and Quality of Life RA Risk Factors Pathophysiology of RA Diagnosis and Natural History of RA Diagnostic Tests and Radiography Natural History and Progression of RA Disease Management Treatment Strategies Summary Continuing Education Posttest Evaluation Form

Counseling Points - October 2007

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