By Dr Ananya Mandal, MD
Rheumatoid arthritis (RA) does not have a cure. It is a progressive disease that leads to steady joint damage and severe debility. The main outcomes of rheumatoid arthritis include:
continuing and persistent joint inflammation
progressive joint damage
progressive decline in joint movement and function
Other major prognosis and outcomes include features of other systems like inflammation of blood vessels (vasculitis), heart disease, infections etc.
The main goal of treatment is to achieve a remission where there is no active joint inflammation and no progressive deterioration of the joints by erosion of the ends of the bones. Remission also means no further deterioration of the functional capability of the joints that are affected. It is only in 10–50% of patients with early rheumatoid arthritis that such a remission is seen.
Reduce pain and progression of the disease
Another major goal of therapy is to reduce pain and progression of the disease along with maintenance of function of the joints while maintaining capability for work and recreational activities. Therapy also aims at improving the quality of life and the personal perception of the disease burden.
Rheumatoid arthritis and early death
Rheumatoid arthritis increases the risk of early death. Those with rheumatoid arthritis are two times more likely to die than persons of the same age without the condition. Rheumatoid arthritis in addition accounts for 22% of all deaths from arthritis and other rheumatic conditions.
With improvement in treatment the hospital admission rates, joint replacement rates as well as the previously seen high mortality rates in severe cases is on the decline. Apart from therapy and new modalities of treatment, early diagnosis, physiotherapy, and changes and improvements in care delivery is responsible for these improvements in adverse outcomes of rheumatoid arthritis to a certain extent.
Self care in rheumatoid arthritis
Rheumatoid arthritis diagnosis and therapy can alter several facets in life. The pain, stiffness and loss of function may be progressive and non-retractable in many cases. This makes adequate care important to delay debility as long as possible.
Maintaining a healthy body weight, exercising regularly, eating a healthy balanced diet as well as quitting smoking are some of the lifestyle measures that can be adapted to effectively deal with minor discomforts and prevent long term adverse effects due to rheumatoid arthritis.
Rheumatoid arthritis due to its effects of mobility and functioning may lead to anxiety and depressive disorders. Maintaining a healthy lifestyle along with a positive outlook may help prevent early development of fatigue, pain, and depression.
To keep the disease under control and prevent flare ups regular reviews and checkups with the healthcare team are also important. Regular vaccinations (against influenza and pneumococcal pneumonia etc.) can help prevent infections and complications associated with a weakened immunity that is seen in treated rheumatoid arthritis patients.
Reviewed by April Cashin-Garbutt, BA Hons (Cantab)