7What are the consequences of early rheumatoid arthritis for the individual?
Section snippets
Assessing the impact of chronic disease
As discussed by Carr9, given our current inability to prevent or cure RA, the primary aim of care should be to reduce the impact of the disease on patients' lives. This major focus on improving quality of life and reducing or postponing disability necessitates the development of formal methods for measuring a patient's experience of disease. Such methods focus on the patient's ability to perform daily living tasks and on more global aspects of their quality of life. Various frameworks have been
Patients' perspectives: pain
Pain is a dominant concern of patients with RA, and its persistence is a highly negative consequence of disease. Drugs currently used in arthritis include analgesics, anti-inflammatory drugs, disease-modifying antirheumatic drugs (DMARDs) and biologicals to target pain relief. Unfortunately, although controlling pain is one indication of successful treatment, many early RA patients continue to suffer pain despite therapy. Pain, generally assessed using a visual analogue scale, has been examined
The functional consequences of RA: disability
Disability in RA can be measured using either generic measures, such as the SF-36 and Nottingham Health Profile, or disease-specific measures, such as the HAQ or the Arthritis Impact Measurement Score (AIMS). The advantage of generic measures is that disability can be compared with other diseases, but such measures are relatively insensitive with significant ceiling and floor effects. The disease-specific measure, AIMS, is a good measure but is complex and therefore has not been widely adopted.
Societal consequences of RA
RA has many consequences, not only for the individual but also for their friends and family and for the whole of society. The total costs of RA (both medical and societal costs, termed ‘indirect costs’) seem to have similar drivers across Western industrialized countries, although these will clearly be very different in developing nations. In the Western world, costs have been studied in detail in established RA57, although there are only limited analyses in early RA.58
A Norwegian study,
Acknowledgements
We are grateful to the ARC for supporting our programme of research.
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