Arthritis Treatment: The Costs Of Not Treating Rheumatoid Arthritis Aggressively

Rheumatoid arthritis (RA) is the most common inflammatory form of arthritis, affecting more than 2 million Americans. It is a chronic autoimmune inflammatory disease that causes systemic problems, meaning it can affect internal organs, such as the lungs, heart, bone marrow, and eye. It is also a major risk factor for the development of cardiovascular complications such as stroke and heart attack.

Added to these concerns is the major issue with rheumatoid arthritis which is that if not treated aggressively, it can lead to irreversible joint damage, chronic pain, and functional disability.

While there is still no cure for the disease yet, RA can be treated and even put into remission if diagnosed early and treated with urgency.

While many of the new medicines that have been developed in recent years are effective, there is still no consensus on which one to use first, which one to use second, when to switch drugs, when is the right time to discontinue one drug and move onto another, and so on.

Perhaps, in time we will be able to individualize treatment programs. Progress in the field of what are called "biomarkers"- tissue evidence that will give us a unique profile of any given patient- will take us to the next level of treatment.

A bright spot is the continued development of newer therapies with different modes of action that will allow more choices, fewer side effects, and more convenience.

Nonetheless, what is clear right now is that delaying proper treatment leads to functional decline that is difficult, if not impossible, to reverse.

This loss of physical function leads to reduced productivity and increased healthcare costs.

A number of studies have viewed various treatment options and shown that a combination of methotrexate, the disease-modifying anti-rheumatic drug (DMARD) of choice along with a biologic drug leads to a significantly greater chance of improvement and less likelihood of unemployability.

Another study has demonstrated that length of time of disease and degree of functional impairment correlate with higher medical costs and greater disability.

And an additional study by Maetzel and colleagues indicated that RA costs also appear to be higher than that due to other common medical conditions such as osteoarthritis and hypertension (Maetzel A, et al. Ann Rheum Dis 2004; 63: 395-401).

The major hurdle today is getting patients with early RA to a rheumatologist early and having the rheumatologist initiate aggressive treatment as soon as possible. More about this in future articles.