What are the consequences of early rheumatoid arthritis for the individual?
Rheumatoid arthritis (RA) has important impacts on health that can be related to the World Health Organization's new International Classification of Functioning, Disability and Health (ICF framework). The physical consequences of RA for the individual relate to body functions and structures in the ICF framework. The functional consequences of RA are related to activity in the ICF framework, and the impact of RA on society relates to participation in the ICF framework. Despite conventional treatment, early RA continues to result in significant physical consequences for most patients. From the patients' perspective, this primarily results from persistent pain, although symptoms such as fatigue and depression are also relevant. This is confirmed from the clinician's perspective by the infrequency of remission, persistence of disease activity and unrelenting radiographic progression in early RA. Patients with early RA often progress, within only a few years, to significant disability. This has mainly been shown in studies using the Health Assessment Questionnaire as the disability measure, although a small number of studies using generic health measures such as Short Form-36 have reached similar conclusions. RA patients and their friends and families incur the majority of costs associated with early RA. Many patients are not able to continue to work at the same level as they would have anticipated had they not developed RA. Later on, society bears an increased load, especially in patients with higher levels of disability; this results from major social care costs and interventions such as surgery. However, the evidence favouring expensive biological therapies, even in early RA, is likely to turn this analysis on its head in the near future.
Scott
David L
DL
Department of Rheumatology, Kings College Hospital, Denmark Hill, London SE5 9RS, UK. david.l.scott@kcl.ac.uk
Smith
Claire
C
Kingsley
Gabrielle
G
D001172:Arthritis, Rheumatoid / Q000150:complications* / Q000175:diagnosis / Q000534:rehabilitation; D017281:Cost of Illness; D004185:Disability Evaluation; D018450:Disease Progression; D042241:Early Diagnosis; D006304:Health Status; D011788:Quality of Life; D012219:Rheumatology / Q000379:methods*; D012720:Severity of Illness Index; D018434:Sickness Impact Profile; D011795:Surveys and Questionnaires