Challenges

CHALLENGES AND UMET NEEDS

 

ECONOMIC AND DISEASE BURDEN

 

• Patients with RA have substantially lower health-related quality of life (QOL) than the general population, with lower overall scores for physical and mental health across all age groups.¹
• The RA disease burden is also associated with increased health care resource utilization.²
• RA patients with low QOL are twice as likely to be hospitalized as RA patients with high QOL.²

• Total direct medical costs are estimated at $12,509 for all RA patients using any treatment regimen and $36,053 for biologic DMARD users.³

• RA results in high direct costs (medications, devices and hospitalizations), indirect costs (decreased productivity and reduced income) and intangible costs (reduced quality of life and premature mortality).
• Workers with RA had costs related to reduced work performance 2 to 4 times higher than workers without RA.⁴

 

COMORBID CONDITIONS

 

Even before its clinical onset, patients with RA are at increased risk of coronary heart disease (CHD).⁵

• As CHD manifests differently in RA, a higher risk of unrecognized MI and sudden cardiac death is evident, along with a lower likelihood of angina symptoms.⁵
• Cardiovascular mortality is at least 1.5-fold higher in the RA population than in the general population, and it probably relates to a combination of differences in traditional cardiovascular risk factors and RA disease–related factors.^6,7

RA-associated fatigue is rarely a target of treatment and has been infrequently assessed .⁸

• A study of 133 adults with longer duration of RA reports a high degree of fatigue that causes moderate distress, remains consistent during the course of a week, and affects discretionary and nondiscretionary activities of daily living.⁹

• Fatigue has also been found to be a strong indicator of overall health status, along with work dysfunctionality.¹⁰

Anemia is also common in RA patients, occurring in 40 to 49 percent of these individuals.^11,12

• RA patients have been found to have anemia – particularly in the presence of a low hemoglobin level at baseline – which is an independent contributor to disability and diminished physical function (P<.001).¹³

 

MORTALITY GAP

 

• The mortality rate for RA has significantly declined since 2006, which is likely to be attributed to improved cardiovascular mortality.¹⁴
• The mortality rate for RA is currently 26.90 per 1000 person-years compared to 18.92 per 1000 person-years for controls.¹⁴

 

 

ACHIEVABLE OUTCOMES

 

Although the achievable outcomes for RA continue to evolve and improve, not all patients are able to attain the desirable treatment goal of remission or, failing that, of low disease activity (LDA).¹⁵

• Following the introduction of the first biologic agent, many RA patients now have drugs available to them that effected a marked improvement in the quality of their lives, with a reduction of signs, symptoms, and structural progression of disease.

• No agent is universally effective in all patients with RA, reinforcing the need for additional agents that reduce RA’s joint inflammation and slow structural progression.

• Quantitatively-driven treatment of RA, aiming for a specific target of reduced disease activity, results in greater clinical improvement and a larger reduction in structural damage .^16,17

• Success can be measured by the reduction in the Disease Activity Score (DAS), indicating the level of RA disease activity at a given point in time.
• Treatment strategies that advance therapy as to reduce the DAS to “low disease activity” or “remission” levels should be utilized during the care for RA patients.

 

REFERENCES

1. Uhlig T, Loge JH, Kristiansen IS, Kvien TK. Quantification of reduced health-related quality of life in patients with rheumatoid arthritis compared to the general population. J Rheumatol.2007;34:1241–1247.
2. Ethgen O, Kahler KH, Kong SX, et al. The effect of health related quality of life on reported use of health care resources in patients with osteoarthritis and rheumatoid arthritis: a longitudinal analysis. J Rheumatol. 2002;29:1147–1455.
3. Hresko A, Solomon D. Medical care costs associated with rheumatoid arthritis in the US: A systematic literature review and meta-analysis.  Arthritis Care Res (Hoboken). 2018;70:1431-8.
4. Braakman-Jansen LM, Taal E, Kuper IH, van de Laar MA. Productivity loss due to absenteeism and presenteeism by different instruments in patients with RA and subjects without RA. Rheumatology (Oxford). 2012;51(2):354-356.
5. Maradit-Kremers H, Crowson CS, Nicola PJ, et al. Increased unrecognized coronary heart disease and sudden deaths in rheumatoid arthritis: a population-based cohort study. Arthritis Rheum.2005;52:402–411.
6. Gonzalez A, Kremers HM, Crowson CS, et al. Mortality trends in rheumatoid arthritis: the role of rheumatoid factor. J Rheum. 2008;35(6):1009-1014.
7. McInnes IB, Schett G. The pathogenesis of rheumatoid arthritis. N Engl J Med. 2011;365(23):2205-2219.
8. Kalyoncu U, Dougados M, Daurès JP, Gossec L. Reporting of patient reported outcomes in recent trials in rheumatoid arthritis: a systematic literature review. Ann Rheum Dis. 2009;68:183–190.
9. Belza BL, Henke CJ, Yelin EH, et al. Correlates of fatigue in older adults with rheumatoid arthritis. Nursing Research. 1993;42:93–99.
10. Wolfe F, Hawley DJ, Wilson K. The prevalence and meaning of fatigue in rheumatic disease. J Rheumatol. 1996;23:1407–1417.
11. Davis D, Charles PJ, Potter M, et al. Anaemia of chronic disease in rheumatoid arthritis: In vivo effects of tumour necrosis factor α blockade. Br J Rheum. 1997;36:950–956.
12. Peeters HRM, Jongen-Lavrencic M, Raja AN, et al. Course and characteristics of anaemia in patients with rheumatoid arthritis of recent onset. Ann Rheum Dis. 1996;55:162–168.
13. Han C, Rahman MU, Doyle MK et al. Association of anemia and physical disability among patients with rheumatoid arthritis. J Rheumatol. 2007;34:2177–2182.
14. Abhishek A, Nakafero G, Kuo C, et al. Rheumatoid arthritis and excess mortality: down but not out. A primary care cohort study using data from Clinical Practice Research Datalink. Rheumatology. 2018;57:977-81.
15. Taylor PC, Moore A, Vasilescu  R, et al. A structured literature review of the burden of illness and unmet needs in patients with rheumatoid arthritis: a current perspective. Rheumatol Int (2016) 36:685–695.
16. Comparison of treatment strategies in rheumatoid arthritis: a randomized trial. Ann Intern Med.2007;146: 406–415.
17. Grigor C, Capell H, Stirling A, et al. Effect of a treatment strategy of tight control for rheumatoid arthritis (the TICORA study): a single-blind randomized control trial. Lancet.2004;364: 263–269.