Counseling Points - November 2008 - (Page 13)

CP Counseling Points Quality of Life and Treatment Options in Rheumatoid Arthritis • The profound pain and fatigue associated with rheumatoid arthritis (RA) limits functional ability, diminishes physical energy, and contributes to emotional distress. • Optimal treatment involves a comprehensive program that includes pharmacological as well as nonpharmacological modalities aimed at reducing pain and discomfort, preventing deformities and loss of joint function, and maintaining a productive and active life. • Two of the most widely used and reliable quality-of-life assessment tools for RA patients are the Health Assessment Questionnaire (HAQ) and The World Health Organization Quality of Life (WHOQOL-BREF) instrument. • Nurses who treat RA patients should provide them with disease education and encourage individuals to evaluate causes of anxiety and learn new ways to adapt to and manage stress. • Radiographic damage, function decrease, and loss of bone mineral density occur very early in the RA disease process. • Nurses should support and educate newly diagnosed RA patients and remind them that bone erosions, cartilage loss, and subsequent deformities are permanent, but may be prevented with early and adequate disease control. • Treatment decisions for RA are made based on several factors: disease duration, disease activity, and prognostic factors. • Monotherapy with the nonbiologic DMARDs leflunomide, methotrexate, or sulfasalazine is recommended for all disease durations and for all degrees of disease activity. • The American College of Rheumatology recommends the use of TNF antagonists (interchangeably) in combination with methotrexate in early RA patients with high disease activity present for less than 3 months with features of poor prognosis and an absence of barriers associated with treatment cost and insurance restrictions. • As beneficial as TNF antagonist treatment has been for many patients, approximately 30% of RA patients fail to respond adequately. • Abatacept is recommended for use in patients for whom methotrexate in combination with DMARDs has led to an inadequate response with at least moderate disease activity and features of poor prognosis. • Rituximab is a B-cell depleting agent used in combination with methotrexate for the treatment of RA. It is recommended for people who have high disease activity, poor prognosis, and inadequate response to methotrexate in combination with DMARDs. ™ 13 NOVEMBER 2008

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Counseling Points - November 2008

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