RA Disability

Living with rheumatoid arthritis (RA) is no walk in the park, but a new study shows that today’s RA patients, on the whole, have an easier time than patients who were diagnosed 20 years ago.

According to a study published in Arthritis Care & Research, half as many RA patients now suffer from anxiety, depression, and physical disabilities as did two decades ago.

Researchers say that early intervention, biologic drugs, and the use of therapy have all helped to decrease RA disease activity for many patients.

As with other autoimmune diseases, compared to the general population, patients with RA are more prone to psychological conditions, such as depression and anxiety. Rheumatologists and other health professionals are well aware of this, said lead study author Cécile L. Overman, a Ph.D. candidate in the Department of Clinical and Health Psychology at Utrecht University in the Netherlands.

Medications to treat RA have improved, and now include biologic agents, which may have a positive effect on psychological distress by blocking pro-inflammatory cytokines, she said. Also, exercise and cognitive behavioral therapy are now more widely used.

“Over the years, research and treatment focus has widened from just trying to cure the disease to focusing more on the patient as a whole, trying to (find out how to) improve the patient's quality of life,” Overman said.

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Half as Many RA Patients Are Disabled Within 4 Years

Between 1990 and 2011, Overman's team examined 1,151 people who had been recently diagnosed with RA. The age of the study participants ranged from 17 to 86, and 68 percent of them were female. After diagnosis, the patients were monitored for three to five years.

The researchers found that, at the start of the study period, 23 percent of patients reported anxiety, 25 percent reported a depressed mood, and 53 percent had a disability. At the end of the study window, they noted that 12 percent of patients reported anxiety, 14 percent experienced depression, and 31 percent were physically disabled.

The scientists determined that about one in four newly diagnosed RA patients are now disabled after the first four years of treatment. But 20 years ago, that figure was two in four, which shows a dramatic improvement, Overman said.

“Compared to 20 years ago, we treat patients much more aggressively,” said Dr. Paul Sufka, a rheumatologist with HealthPartners in St. Paul, Minn. That early, aggressive treatment is key to preventing joint damage, which can lead to disability.

He says the goal now is “treating to target,” which means complete remission for many patients. In the past, that goal was not as well defined.

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A Shortage of Rheumatologists in Rural Areas

While RA patients seem to be doing better than they have in the past, a new study in Arthritis & Rheumatism shows that people in rural areas have a difficult time finding a rheumatologist to diagnose and treat their disease.

The study shows that there are only about 1.7 rheumatologists for every 100,000 Americans. And as more people age, experts say there will be a shortage of 2,500 rheumatologists by 2025—up from their expected shortage of 400 rheumatologists in 2010.

In areas with fewer than 50,000 people, the researchers saw especially limited access. In fact, in 50 of the 479 "micropolitan" areas they studied, patients traveled more than 100 miles to see their physicians. They also noted many regions with more than 200,000 people that had no practicing rheumatologists.

In general, the researchers observed a higher concentration of rheumatology offices in areas with larger populations and higher median incomes.

“Our study highlights that regional shortages of rheumatologists already exist,” said lead author Dr. John FitzGerald of the David Geffen School of Medicine at the University of California, Los Angeles in a statement. “There are a number of communities across the U.S. that would benefit from additional rheumatology services.”

In a related editorial in Arthritis & Rheumatism, Dr. Chad Deal of the Cleveland Clinic in Ohio said that rheumatologists are vital for early RA diagnosis and treatment, which is imperative in the first few months of the disease in order to limit joint damage, improve physical function, and drive remission.

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