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Rheumatoid arthritis patients better off than decades ago

By Andrew M. Seaman

NEW YORK (Reuters Health) - People with rheumatoid arthritis are better off than they were 20 years ago, according to new research from the Netherlands.

Researchers found about half as many people were considered disabled after the first four years of rheumatoid arthritis (RA) treatment in 2011, compared to 1990.

"The results of our study relay the hopeful message to patients that today, in spite of having rheumatoid arthritis, they have a better opportunity to live a full and valued life than 20 years ago," Cécile Overman wrote in an email to Reuters Health.

Overman is the study's lead author and a doctoral student in clinical and health psychology at Utrecht University in the Netherlands.

RA is an inflammatory disorder that often affects the lining of the small joints in the hands and feet. Unlike the more common osteoarthritis, which occurs after years of wear and tear on joints, RA is caused by the body attacking its own tissue.

"It is believed that the tendency to develop rheumatoid arthritis may be genetically inherited," Overman wrote. "It is also suspected that certain infections or factors in the environment might trigger the activation of the immune system in susceptible individuals."

About one in five U.S. adults reports having been diagnosed with arthritis, according to the Centers for Disease Control and Prevention (CDC). Women are more likely to report arthritis than men at any age.

About 27 million Americans had osteoarthritis in 2005, according to the CDC. About 1.5 million had RA.

"Rheumatoid arthritis is a much more daunting diagnosis," Dr. Daria Crittenden, a rheumatologist at NYU Langone's Center for Musculoskeletal Care in New York, said.

"It comes in much younger patients," Crittenden, who was not involved with the study, said. "They go from being completely functional and going about their daily lives to having severe stiffness in many of their joints and pain that keeps them from doing simple things."

For the new study, Overman and her colleagues analyzed data on 1,151 people who were diagnosed with RA between 1990 and 2011. Patients were between the ages of 17 and 86 years old.

They were assessed for anxiety, depression and disability when they were diagnosed with RA and again after four years.

The researchers found that at the start of the study period, 23 percent of patients had anxiety, 25 percent were depressed and a little more than half were physically disabled.

Among people who were diagnosed toward the end of the study period, 12 percent had anxiety, 14 percent were depressed and about 31 percent were physically disabled, the researchers reported in Arthritis Care and Research.

"Improved treatment strategies have shown to be capable of improving patients' psychological well-being and physical functioning," Overman wrote.

"Therefore, treatment improving over the decades is a likely candidate to explain, at least in part, the improvement in psychological well-being and physical functioning."

She stressed, however, that she and her colleagues did not examine any particular treatment and the improvement may be due to better drugs and non-drug treatments, such as therapy.

Overall, the researchers found about half of people diagnosed with RA two decades ago were disabled after four years of treatment. That compared to about one in four people in recent years.

Crittenden said doctors and researchers had believed the treatment of RA led to better outcomes, based on anecdotal evidence - and it's good to see that confirmed.

In addition to better treatments, Crittenden said the improvement may also be due to a greater effort to treat RA early and aggressively.

Overman said it could also be that doctors encourage people with RA to "keep physically active and stressing that it is possible to live a valued life despite RA."

She added that the study is also good news for rheumatologists and health professionals.

"We're on the right track with the changes in treatment focus and strategy that have been gradually implemented over the past decades," she said.

SOURCE: http://bit.ly/1cdfNP3 Arthritis Care and Research, online December 3, 2013.

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