People with rheumatoid arthritis (RA) are likely to have a much better quality of life today than they did two decades ago. Researchers in the Netherlands observed more than 1,100 patients diagnosed with RA between 1990 and 2011. They attribute the gains to earlier diagnosis, more aggressive medications and a greater emphasis on overall well-being. Their findings were published in Arthritis Care & Research in 2014.
Lead author Cecile Overman, a postdoctoral researcher at Utrecht University in the Netherlands, says she and her colleagues wanted to determine if improved treatments over the last 20 years led to better physical and psychological health for RA patients.
In RA, the body’s immune system mistakenly attacks itself, leading to body-wide inflammation that damages not only the cartilage and bones, but also organs such as the heart and lungs. RA is also associated with depression and anxiety rheumatoid arthritis, which for some can be as limiting as physical disability. Although there is no cure for RA, early and aggressive treatment can lead to remission.
In the study, researchers followed several groups patients who were diagnosed with RA at different times over a 20-year period. All were assessed at diagnosis and after approximately four years of treatment. Researchers took into account blood markers of inflammation, the number of painful and swollen joints, depression, anxiety and physical functioning.
Results showed that both mood and physical ability improved as the study progressed over time. For example, about 43% of people newly diagnosed with RA in 1990 reported feeling depressed, whereas 32% of those diagnosed in 2004–2008 did. At follow-up, the numbers were 25% and 14%, respectively. Physical disability was cut in half during the 20-year span.
New Treatment Strategies = Better Disease Control
Disease activity scores decreased over the course of the study. Overman says that although the research does not prove cause and effect, results suggest that the downward trend in physical disability, anxiety and depressed mood results from reduced disease activity. And that, in turn, is probably due to better treatments.
“In our study, as insights evolved, treatment strategies changed across the decades, with pharmacological treatment becoming more intense,” she says. “For example, to keep inflammation and disease progression to a minimum, patients start with stronger medications as soon as possible, are monitored more frequently, and medications are combined for optimal efficacy. Furthermore, when new anti-inflammatory drugs such as biologics became available, their use increased.”
“Nowadays, the future of a newly diagnosed patient with RA looks brighter due to improved treatment possibilities, both pharmacological and non-pharmacological. Patients today are encouraged to keep physically active and the possibilities of a valued life despite RA are stressed,” she points out.
Overman adds that although many studies have noted improved physical functioning among RA patients, few have focused on emotional well-being.
“Compared to the general population, patients with [RA] are more prone to experience psychological distress, such as depression and anxiety,” she explains. “Just focusing on the physical component to assess how patients are doing would be selling them short. Over the years, awareness of the importance of overall patient well-being and functioning has increased among health professionals, and the focus has widened from just trying to cure the disease to trying to find out how to improve the quality of people’s lives.”
Janice McInnes, a physical therapist and clinical supervisor of rehabilitation services at Brigham and Women’s Hospital in Boston, says the “positive experience of both providers and patients” at her institution confirm the Dutch findings.
“Patients who have been diagnosed with a rheumatologic condition can lead active lives and engage in a wide variety of physical activities when their condition is well-controlled,” she says. “As a physical therapist who treats patients with rheumatologic conditions, it is more routine now to see a patient with RA who needs muscle strength and conditioning. In the past, more therapy time was needed to restore basic range of motion and function. Now, physical therapy is just helping them get back in the game.”
Overman concurs, adding, “Patients with rheumatoid arthritis have a better opportunity of living a valued life than patients diagnosed with this disease two decades ago, and I would like to relay this hopeful message.”