People with rheumatoid arthritis (RA) pay the price for living with their condition.

The heavy financial burdens that weigh on some people with RA range from lost wages to skyrocketing medical expenses.

There are also often the intangible factors such as a decrease in quality of life and an increase in stress levels.

If people with RA don’t have enough to worry about, new research suggests there is another price to pay. In addition to physical and emotional pain, people with RA cost the U.S. economy billions of dollars each year.

Arthritis is the leading cause of disability in the U.S., and people are often left unable to continue working. They are left with expensive medical bills, and the economy feels the strain.

The Full Costs of Rheumatoid Arthritis

There are 52.5 million adults with arthritis living in the U.S.

RA directly costs the U.S. about $19.3 billion a year (in 2005 dollars), according to an independent study conducted by doctors and researchers in 2010. A third of that amount was given out to employers. Twenty-eight percent was given out to patients, and about 20 percent to caregivers and the government.

Added in with these costs are reduced quality of life, premature death, and total societal costs. That number reached $39.2 billion (in 2005 dollars).

The statistics from the U.S. Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) are even more staggering.

According to CDC estimates, the total costs from arthritis and related rheumatic conditions were about $128 billion in 2005. However, some estimates place the cost around $353 billion. Some of these costs were for medical expenses and medical payouts, and the rest were from lost wages. These numbers are for all forms of arthritis, not just RA.

For RA, it is estimated that the overall cost of RA drugs is $41 billion worldwide. That figure is projected to grow to $52 billion by 2018.

Lost wages is a significant problem among people with RA. On average, they must go on disability or stop working entirely within two years of disease onset and diagnosis.

The economic burden is notably worse for people with RA than it is for those with other forms of arthritis. People with RA are three times more likely to have a reduction in income. They are also often faced with more financial burdens due to high drug costs, out-of-pocket expenses, and co-pays.

Read More: Learn How to Save on Your Prescriptions »

What Does It Mean for People with RA?

People with RA have to recognize the reality of their situation as a whole, including the economic impact of the disease.

Many people with RA are unable to work and RA medications are among the most expensive drugs with costs often rivaling cancer medications.

Even with health insurance, people with RA frequently face steadily increasing medical bills.

There have been stories of people with RA having to sell their cars or refinance their homes to afford their treatments. Many drug manufacturers and hospital systems do offer financial assistance programs. However, gaining access and acceptance into these programs can be difficult.

“I was stunned when I got a bill for $5,500 … for one month’s worth of my injectable. This is with insurance. I don’t know how people manage these illnesses for years, even decades, without being rich,” Nikki Watson of Bethesda, Maryland, who lives with both RA and lupus, said.

Mark Dowley of Albuquerque, New Mexico, has rheumatoid and osteoarthritis.

“It isn’t unusual for the cash costs of my drugs to be $15,000 or more per treatment. Luckily, I still work, and my insurance covers most of it, because I’d be hopeless without the medical benefits. It’s an awful situation for patients, especially the ones who can’t work,” he said.

Read More: RA Patients Bear Heavy Cost Burden for Biologic Drugs »

The costs of RA medications have gone from about $50 per month to thousands of dollars per month in recent decades.

In fact, sales from RA drugs are the second highest class of pharmaceutical sales worldwide. The biologic class of RA drugs has grown about 45 percent in a five-year period.

It is predicted that medication costs will only continue to increase in coming years.

According to a recent study, from January 2013 to January 2016, the price of Enbrel rose 80 percent, the price of Humira rose 68 percent, and the price of Xeljanz rose 44 percent.

Biosimilars may offer new hope for people who live with RA. These drugs are similar to the more costly biologics, but they may be more affordable and more widely available. The U.S. Food and Drug Administration (FDA) recently approved the first biosimilar drug for RA, which is similar to Remicade.

Read More: What Will the Growth of Biosimilar Drugs Mean for RA Patients? »

Laura Fleck is a nurse in Pittsburgh who often works with people who have autoimmune diseases like rheumatoid arthritis. She also volunteers at a local nonprofit advising people who are in financial distress or considering a vocational or occupational change.

“I advise patients to work as long as they can. Pay into your Social Security. You’ll be entitled to those Social Security disability benefits if you can no longer physically work. Sometimes your employer will offer additional disability benefits. A health savings account is a good idea, too,” she said. “It’s important for patients to just keep trying and just keep hoping. And saving. Conserve your time and energy, conserve your money. Saving is good whether it’s for your health or your wallet.”