December 3, 2013
News Review From Harvard Medical School -- Study: Rheumatoid Arthritis Patients Doing Better
People with rheumatoid arthritis today feel better and have an easier time with daily life than those diagnosed 20 years ago, a study finds. The study included 1,151 people. They were diagnosed with rheumatoid arthritis between 1990 and 2011. Researchers kept track of them for 3 to 5 years. After those few years of treatment, about 23% of people diagnosed 20 years ago reported anxiety. About 25% were depressed. Just over half reported physical disability. These problems were cut in half for people diagnosed just a few years ago. In this group, about 12% reported anxiety and 14% were depressed after 3 to 5 years of treatment. About 31% were disabled. Researchers noted that patients today receive earlier and more intensive treatment. They are encouraged to be physically active. Medicine options also have expanded. The journal Arthritis Care & Research published the study December 3.
By Robert H. Shmerling, M.D.
Harvard Medical School
What Is the Doctor's Reaction?
Chances are good that you or someone you know has arthritis. About 1 in 5 U.S. adults has some form of arthritis, the Centers for Disease Control and Prevention says. And, with the aging of the population, these numbers are expected to increase.
Rheumatoid arthritis is one of more than 100 types of arthritis. It affects about 1% of the population. It has long been called "the crippling type" of arthritis because it can destroy joints quickly. Because it tends to start during young adulthood or middle age, its impact can be devastating.
But the news about arthritis isn't all bad. A new report demonstrates what many arthritis experts have noticed: Among people with rheumatoid arthritis, the rate of disability is falling. The psychological health of people with rheumatoid arthritis also seems to be improving.
The study enrolled people whose rheumatoid arthritis was diagnosed between 1990 and 2011. After the first 4 years of treatment, those who were diagnosed recently were less likely to be:
- Disabled -- In the 1990s, the rate of disability was 53%. But this fell to 31% among those more recently diagnosed.
- Anxious -- Twenty years ago, the rate of reported anxiety was 23%. It was only 12% among those more recently diagnosed.
- Depressed -- The rate of depression was 25% in the 1990s, but only 14% in recent years.
Why are these numbers getting so much better? It's tempting to believe that the improvement is the result of better drugs and a more aggressive approach to treatment. After all, big changes have occurred in treatment of rheumatoid arthritis in the last 20 years. They include:
- Earlier treatment
- An approach that aims to completely halt joint inflammation
- A host of new drugs
But researchers compared patients reporting similar degrees of disease control, in the past and now. They still found that more recently diagnosed people were doing better. So better control of disease isn't the whole story.
These findings are encouraging. They are a testament to remarkable advances in research and development of new drugs for rheumatoid arthritis in recent years. But these findings also point out how far we have to go. Even among those most recently diagnosed and treated, nearly one-third of people with rheumatoid arthritis report major disability. And a significant proportion of those with rheumatoid arthritis don't improve much with treatment, have serious side effects or both.
What Changes Can I Make Now?
The cause of most types of arthritis -- including rheumatoid arthritis -- is unknown. So there's nothing you can do to prevent it.
However, we do know several factors that increase the risk of arthritis. Some, such as family history, can't be changed. But others can be. You may be able to reduce your risk of some of the most common types of arthritis. Here's what you can do:
- Don't smoke. Smoking increases the risk of rheumatoid arthritis, so not smoking may reduce your risk.
- Improve your oral health. Gum inflammation (gingivitis) caused by certain bacteria has been linked to rheumatoid arthritis (though we don't know why). Good oral hygiene and regular dental care may lower the risk.
- Maintain a healthy weight. Obesity increases the risk of osteoarthritis, the most common type of arthritis and the most common reason for knee and hip replacements. Osteoarthritis becomes more common with age and tends to run in families. But millions of cases might be prevented by avoiding excessive weight gain.
- Avoid trauma. Injury also increases the risk of osteoarthritis. Avoiding injury may prevent some cases of osteoarthritis. Measures to avoid injury include:
- Proper athletic training
- Proper athletic technique
- Not taking unnecessary risks at work or at play
See your doctor if you have joint pain, especially if you also have joint swelling or impaired function. Early diagnosis and treatment can make a big difference in your future joint health.
What Can I Expect Looking to the Future?
Several new treatments for rheumatoid arthritis have been approved in recent years. More are in development. But it's not clear whether the newest medicines and the ones likely to be approved in the coming years are better than what we already have.
Even so, given the progress made in the last two decades, it seems likely that people with rheumatoid arthritis will improve even more in the future. You can expect more research to find out whether we are making progress in arthritis treatment. It certainly seems to be true for rheumatoid arthritis. It will be important to understand what we are doing right.