Burden of disease in treated rheumatoid arthritis patients: going beyond the joint.
OBJECTIVE
The disease burden in rheumatoid arthritis (RA) extends beyond the joint. This article evaluates the physical and psychosocial extra-articular burden of treated RA and relationships among diverse disease manifestations.


METHODS
MEDLINE searches identified papers published in English from January 2003 to December 2012 that evaluated systemic complications and psychosocial aspects associated with RA. Preference was given to studies with randomized cohorts and large (>100) sample sizes. Of 378 articles identified in the initial search, 118 were selected for inclusion.


RESULTS
RA is associated with multiple comorbidities and psychosocial impairments, including cardiovascular disease, osteoporosis, interstitial lung disease, infection, malignancies, fatigue, depression, cognitive dysfunction, reduced work performance, work disability, and decreased health-related quality of life. The etiology of the extra-articular burden may reflect the systemic inflammation and immune system alteration associated with RA, metabolic imbalances and side effects related to treatment, or the influence of comorbidities. Strategies that may help to reduce the extra-articular disease burden include personalized medicine and the potential introduction of treatments with new mechanisms of action.


CONCLUSIONS
Despite improvements in treating joint disease, the extra-articular burden in RA remains substantial, encompassing multiple comorbidities and psychosocial impairments.
Research Laboratories and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, Viale Benedetto XV 6, Genoa 16132, Italy. Electronic address: mcutolo@unige.it.
Maurizio
M
Cutolo
Clinical Rheumatology and R&D Director, Department of Rheumatology, Dudley Group NHS Foundation Trust, Dudley, United Kingdom; and Arthritis Research UK Epidemiology Unit, University of Manchester, Manchester, UK.
George D
GD
Kitas
Rheumatology, Department of Rheumatology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
Piet L C M
PL
van Riel
D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000150:complications* / Q000188:drug therapy / Q000473:pathology; D002318:Cardiovascular Diseases / Q000150:complications* / Q000473:pathology; D017281:Cost of Illness; D006801:Humans; D007249:Inflammation / Q000473:pathology; D007596:Joints / Q000473:pathology; D011788:Quality of Life
D018501:Antirheumatic Agents