Counseling Points - October 2007 - (Page 9)

50% to 60% of patients with early RA (as early as 3 to 6 months after the beginning of symptoms). The ACR states that approximately 95% of patients with a positive CCP will develop RA in the future.20 Even if a clinician is confident about an RA diagnosis, many times other laboratory tests that analyze platelet counts, hemoglobin/hematocrit, and immunoglobulins are ordered to rule out other inflammatory conditions. Radiographic studies are extremely useful for the initial clinical evaluation of RA and can also identify disease progression and remission.21 Plain film radiography (x-ray) is the most common imaging tool used for the initial evaluation of RA.21 Results from x-rays can confirm a diagnosis even in the absence of clinical and laboratory evidence and can be used to document the location and degree of joint disease. Soft tissue swelling, marginal erosions, osteopenia, and uniform joint space loss may be seen on x-rays relatively early in the disease process, particularly in the hands, wrists, and feet.21 In addition, magnetic resonance imaging (MRI) offers increased sensitivity and is superior to plain film radiography in detecting inflammatory changes and erosions earlier in the disease process.21 Ultrasound is also being implemented more often to evaluate RA. It is a less expensive modality than MRI and is a more comfortable procedure for the patient to undergo.21 In addition to physical examination, laboratory values, and radiographic studies, some rheumatologists also will ask patients to complete a variety of clinical assessment tools. These tools include questionnaires, such as the Disease Activity Score (DAS) and the ACR 20/50/70 Response Criteria, that measure signs and symptoms of the disease.3 The Stanford Health Assessment Questionnaire (HAQ) and the Short Form-36 (SF-36) Health Survey are other surveys that evaluate functional disability and quality of life measures. 3 A number of studies have found that patient selfassessment questionnaire scores correlate with ESR levels, x-ray results, and physical measures. acute, gradual, or subacute.22 Disease course can vary markedly among individuals affected and may range from self-limiting disease to progressive arthritis with severe disability. For example, some individuals develop RA symptoms that last only a few months or a year and then resolve without causing noticeable damage. Other patients experience a fluctuating disease course that is characterized by symptom flares and remissions. Yet other individuals suffer from a severe form of the disorder that is chronic and active most of the time, and leads to profound joint damage and physical disability. Early in the disease, there are no criteria that can predict the resolution or progression of RA in a specific patient.23 If left untreated, RA invades and destroys cartilage and eventually erodes bones. Progression of joint damage in RA is a complex process. If left untreated, the disease invades and destroys cartilage and eventually erodes bones. It begins as synovitis, advances to joint destruction, and finally evokes deformity.1,16 Radiographic joint damage, such as erosions and narrowing of joint space, occurs early and is persistent and progressive, especially during the first 2 years of disease. As the disease advances, joint subluxation and malalignment and ankylosis become apparent on x-rays.21 Disease Management Goals of effectively managing RA include prevention or control of joint damage, preservation of function, and reduction of pain.3 At each follow-up visit, the clinician should thoroughly assess the RA patient to determine if the disease is active or inactive (Table 2).3 Evaluation of inflammatory symptoms, functional status, periodic laboratory testing and radiographic examinations, and quality of life assessment by use of questionnaires should be performed.3 If decline in function and diminishment of quality of life are identified, the clinician must determine whether it is a result of inflammation, mechanical damage, or both. 9 OCTOBER 2007 Natural History and Progression of RA The clinical course of RA follows an onset that may be

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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