9What are the goals and principles of management in the early treatment of rheumatoid arthritis?
Section snippets
What are the goals of management—disease remission or control, maintaining function, maintaining quality of life?
The impact of RA can be devastating. Up to 50% of patients with ERA will be unable to do their job after 3 years of disease.1 It is not uncommon for job loss to occur even before the patient has seen a rheumatologist. Patients who lose their job and function experience secondary loss of self-esteem and depression. The primary goal of therapy is to achieve early remission of the disease with sustained therapy, as sustained remission in patients with longstanding disease if medications are
What is the role of patient education?
The goals of education for patients with new-onset RA are improved patient-physician communication, increased understanding of their condition, better adherence to treatment and a change in behavior to improve pain, disability and psychosocial wellbeing. Patient education programmes should compliment medical treatments by providing strategies and tools to make the necessary decisions to better cope with the patient's illness. A better comprehension of the disease process, possible outcomes,
What is the role of self-management?
RA is known to have an unpredictable course and prognosis, and a negative psychosocial impact. Barlow8 performed an RCT of a psycho-educational intervention known as the Arthritis Self-Management Program (ASMP) in 544 patients with osteoarthritis. The ASMP was found to be effective in terms of improving perceptions of control (i.e. arthritis self-efficacy), use of self-management techniques such as communication with physicians, cognitive symptom management, exercise, and health status in terms
Occupational therapy (OT)
OT for patients with RA can include training of skills, counseling, education about joint protection, prescription of assistive devices, provision of splints, advice/instruction in the use of assistive devices, training in self-care activities, and training in productivity activities. Steultjens11 reviewed the efficacy of OT interventions for RA. Seven different intervention categories were identified (comprehensive OT, training of motor function, training of skills, instruction on joint
What is the role of exercise?
The goal of exercise for any individual is to maintain or improve physical fitness. In order to achieve this, patients need to participate in exercise programmes over a prolonged period. For this reason, Hakkinen et al evaluated the impact of a 2-year home-based strength-training programme on physical function in patients with ERA after a subsequent 3-year follow-up.14 They randomized 70 patients with ERA to perform either strength training [experimental group (EG)] or range-of-motion exercises
What is the role of diet?
When patients are first diagnosed with RA, they must deal with the new sense of loss of control over their health. They frequently ask what they can do to help manage their disease, and inherent in this are questions about how they should modify their diet and whether dietary modifications can control or even cure their RA. There are now a number of studies of dietary interventions that have shown some benefit in RA. These are discussed below to provide healthcare providers with an
What is the role of drug management?
At this point in the evolution of disease management of ERA, drug therapy remains the most critical aspect of treating this disease. Pharmacological and biological therapies have been shown to be the most rapid acting and have the largest effect on controlling the inflammatory process in this disease. At the present time, no therapy can cure the disease. No drug can be withdrawn once the disease is in remission without a significant risk of the disease returning.
The main goal of drug management
Summary
Evidence has been presented that a diet high in anti-oxidants (vegetables, olive oil) and PUFAs (fish oils) is likely to have a moderating effect on RA. Psycho-educational interventions have only shown short-term benefit, but it is likely that these have not been evaluated for the appropriate specific outcome measures (i.e. adherence, depression). Physical exercise such as dynamic strength training has been shown to improve function and reduce disease activity in patients with ERA. Although the
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Cited by (20)
Characteristics and development of the patients therapeutic education in rheumatoid arthritis: Analysis of the literature between 2003-2008
2010, Revue du Rhumatisme (Edition Francaise)Management of established rheumatoid arthritis with an emphasis on pharmacotherapy
2007, Best Practice and Research: Clinical RheumatologyCitation Excerpt :Nowadays, RA is treated as early as possible, sometimes even before the diagnosis of RA has been established.6 The ultimate goals in the management of early RA are complete suppression of the disease process, regaining full function and prevention of joint damage, with the aim of stopping the disease process before it completely evolves.7–10 The management of early RA has been discussed in Chapter 2.
A detailed analysis of treatment delay from the onset of symptoms in early rheumatoid arthritis patients
2014, Scandinavian Journal of RheumatologyEthanolic extracts of Moringa oleifera Lam.: Evaluation of its potential as an antioxidant additive for fish oil
2013, Journal of Thermal Analysis and Calorimetry