Rheumatoid arthritis (RA) is the most common form of inflammatory arthritis affecting approximately two million Americans.
It is a systemic, chronic, progressive, autoimmune disorder. While it preferentially attacks joints, it may affect other organ systems as well. These other areas include the lungs, heart, peripheral nervous system, skin, bone marrow, and eyes.
When RA is suspected, a patient needs to be referred to a rheumatologist (arthritis specialist) as soon as possible. The current goal of RA therapy is to treat and control disease before any joint damage has occurred. A rheumatologist can help by establishing an accurate and early diagnosis and initiating disease-modifying anti-rheumatic drugs (DMARDS) to slow down disease and possibly put it into remission as soon as possible.
Numerous studies support the early use of DMARDS as well as biologic therapies to reduce and prevent joint damage as well as systemic complications.
The treatment target is either remission or what is termed "low disease activity."
Despite the evidence that aggressive therapy is effective, patients sometimes discontinue therapy.
Treatment is stopped often as a result of lack of effectiveness or because of side effects. These include infection, lung issues, and rarely lymphoma.
Studies have indicated that lack of efficacy is more often the reason for treatment discontinuation than is the development of side effects.
Another reason for treatment stoppage is inconvenience. Some therapies require intravenous infusions every four weeks and this can be tedious as well as difficult to fit into a patient's schedule. Other therapies require that a patient administer a subcutaneous injection to themselves. The frequency of dosing can range anywhere from once a week to once a month. Some biologics are painful when administered via this route.
Other patients may discontinue therapy once their symptoms subside or they go into remission, conveniently forgetting how bad their disease once was. It is important to remind the patient not only how bad their symptoms were when they first presented but also to let them know their symptoms could recur quickly. Another point is to remind them of the potential systemic complications of the disease.
One reason some patients stop treatment is because of the high cost of these medications. Biologic drugs are extremely expensive and if a patient's insurance plan requires a percent co-pay, the monthly price can be quite steep. Some patients may be eligible for assistance through the pharmaceutical company. Also, samples may be available from the physician.
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