Counseling Points - November 2008 - (Page 6)

Table 2. Strategies for Improving Quality of Life in RA5 • Pharmacological treatment • Weight loss • Exercise • Nutritious diet • Appropriate rest • Assistive devices • Physical and occupational therapy • Individual cognitive therapy, family/marriage counseling • Support groups • Arthritis self-help programs • Meditation & relaxation techniques • Massage/spa treatments • Light therapy aggressive therapy with disease-modifying antirheumatic drugs (DMARDs), which slow or stop the progression of the disease, has become the standard of care for patients with RA.6,12,13 In the past, concerns about the toxicity of DMARDs led to their use being delayed as long as possible.12 However, today it is recognized that the risks of toxicity are outweighed by the consequences of delay in treatment.12 Because of the potential for serious joint damage without proper drug therapy, the American College of Rheumatology (ACR) recommends that RA patients consult a rheumatologist within 3 months after symptom onset to initiate DMARDs as soon as possible.12 Without early pharmacological intervention: • joint destruction occurs in 60% to 98% of patients. Up to 93% of patients with <2 years of RA symptoms have radiographic abnormalities;12 • decreased physical function, low quality of life, disability, and underemployment can be expected;12 • the risk for comorbidities significantly increases;13 and • life expectancy is reduced by 5 years to 15 years.6 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. Appropriate pharmacotherapy with DMARDs initiated early in the disease process can also help to greatly improve quality of life for patients.12 When pain and inflammation caused by the disease are controlled, patients report an enhanced feeling of well-being and higher satisfaction with their treatment regimens.5 tine. In addition, patients are taught methods to manage fatigue and stress and are offered coping strategies to effectively deal with anger, fear, frustration, and depression. Results from studies assessing the program have indicated that participants report a 20% decrease in pain and a 40% reduction in physician visits even 4 years after course participation.5,10 Patients can go online at www.arthritis.org to the “Events and Programs” section and enter their zip code to find a local program, support groups, and other arthritis-specific services in their community.5,10 Determining the Most Efficacious Treatment for RA Patients Early Diagnosis of RA RA is a rapidly progressing disease with increasing severity; spontaneous remission is rare.11,12 There is an abundance of evidence that demonstrates a substantial portion of radiographic damage, function decrease, and loss of bone mineral density very early in the disease process.11,12 In fact, about 40% of patients have radiographic erosions at their first visit to a rheumatologist, while synovitis is likely to be much more widespread at presentation than is indicated by conventional clinical examination.6,13, Therefore, early, COUNSELING POINTS™ 6 2008 ACR DMARD Guidelines Treatment decisions for RA take into consideration several factors: disease duration, disease activity, and prognostic factors. The ACR recently published updated guidelines for the use of non-biologic and biologic DMARDS based on these factors.12 Disease Duration and Prognosis Disease duration is of foremost importance in predicting an individual’s response to DMARD therapy. Initiating drug therapy earlier versus later in the disease process produces significantly better therapeutic outcomes.12 Disease http://www.arthritis.org

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Counseling Points - November 2008 Welcome Quality of Life and Treatment Options in Rheumatoid Arthritis Counseling Points

Counseling Points - November 2008

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