Counseling Points - October 2007 - (Page 5)

year reduction in life expectancy. 7 Early death occurs generally not from the disease itself, but from comorbid conditions.7,8 Studies have found that a high number of patients with RA also repor t other co-existent medical conditions, such as infection, malignancy, cardiovascular disease, depression, peptic ulcer disease, and chronic lung disease. On average, patients with established RA have two or more comorbidities.8 Individuals affected by the disorder are twice as likely to suffer a myocardial infarction (MI) and 70% more likely to be affected by a stroke or an infection than people who do not have RA. In addition, RA patients have a significantly increased risk of developing lymphoma—up to a 26-fold higher risk than the general population, depending on the individual’s disease sever ity and degree of exposure to immunosuppressive drugs, such as methotrexate.9 on quality of life.12 The profound pain and fatigue associated with the disease limit functional ability and often contribute to emotional distress. An assessment by Wolfe and colleagues found that fatigue was a predictor of work dysfunction and a general measure of health status and satisfaction.12 Results from 1,488 patients who completed the Clinical Health Assessment Questionnaire (a patient self-assessment survey) demonstrated that approximately 81% of patients surveyed experienced fatigue with over 41% reporting severe fatigue. Consequently, up to 40% of patients indicated that they suffered from depression due to their disease, and that emotional distress impacted the quality of their personal and family lives. RA Risk Factors Although a specific cause for RA has yet to be determined, it is thought that the disease is generated from the combination of genetic susceptibility and exposure to environmental risk factors.1 RA is generated from the combination of genetic susceptibility and exposure to environmental risk factors. Genetics Genetic make-up plays a critical role in the development of RA and it is suspected that susceptibility to the disease may be, in part, an inherited trait.1,10 It is thought that infectious organisms, such as viruses, may promote the onset of the disease in individuals who are genetically predisposed. Identical twins show a 30% to 50% concordance for the disease, and 80% of firstdegree relatives of patients with RA have an approximate 2-fold to 3-fold increased incidence of being affected by the condition.1,10 In addition, siblings of patients with seropositive, erosive RA have an estimated risk of developing the disease that is between 5 and 10 times greater than that of the general population.1 However, genetic factors do not fully account for the incidence of RA, suggesting that environmental factors also play a role in its etiology. RA Costs and Quality of Life RA contributes to over 250,000 hospitalizations and 9 million physician visits each year.10 The economic burden associated with the condition is significant and is similar to that of coronary artery disease.1 The direct costs of RA are substantial, but indirect costs have been calculated to be much higher because of the extensive co-morbidity associated with the disease. A recent cost of illness study by Maetzel and colleagues compared the economic burden to society incurred by patients with RA, osteoarthritis, and hypertension.11 Estimated total annual costs for RA patients were $9,300 compared to osteoarthritis and hypertension costs of $5,700 and $3,900, respectively.11 The investigators noted that the increased costs associated with RA were due to higher loss of productivity and testing costs and more costly expenditures on visits to specialists than those associated with the other two conditions.11 Furthermore, RA has a markedly negative impact 5 Gender Women are three times more likely than men to develop RA.13 It is unknown whether men are somehow protected from RA or whether females are just more OCTOBER 2007

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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