Is Disability Inevitable With Rheumatoid Arthritis?

Should You Be Worried?

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Not too many years ago, rheumatoid arthritis was referred to as the most crippling or disabling type of arthritis. That's a somewhat gloomy prognosis that gets handed over with the diagnosis, making it no wonder that patients fear what lies ahead. The potential consequences of physical limitations and disability weigh heavily on the mind. People diagnosed with rheumatoid arthritis wonder if they will be able to continue performing in their roles and responsibilities at home and at work.

They also wonder how difficult usual daily activities may become. Since chronic illness brings with it an element of the unknown, a certain amount of concern is normal and understandable. How worried should people be? Is disability inevitable with rheumatoid arthritis?

Arthritis Is Most Common Cause of Disability

According to the CDC website, "47.5 million US adults (21.8%) reported a disability in 2005. Arthritis or rheumatism continues to be the most common cause of disability, while back or spine problems and heart trouble round out the top three causes. Among adults reporting a disability, the most commonly identified limitations were difficulty climbing a flight of stairs (21.7 million, 10.0%) and walking 3 city blocks (22.5 million, 10.3%). That means that 1 in 10 adults have trouble walking a distance equal to walking from the parking lot to the back of a large store or through a mall." This speaks of all types of arthritis and rheumatic disease.

Not just rheumatoid arthritis.

Also, according to the CDC, "People with rheumatoid arthritis have been reported to experience more losses in function than people without arthritis in every domain of human activity including work, leisure and social relations."

According to Rheumatoid Arthritis: Early Diagnosis and Treatment, after 8 to 11 years of having rheumatoid arthritis, 43% to 85% can no longer work.

Consequently, rheumatoid arthritis reduces lifetime earnings by 50% to 63%.

Prevalent or Inevitable?

While disability associated with rheumatoid arthritis is prevalent, is it inevitable? We know that early diagnosis and early treatment can make a difference. Newer and better treatments can make a difference. According to Kelley's Textbook of Rheumatology, failure of rheumatoid arthritis patients to respond to treatment within the first 6 months, at least the level known as ACR20 (20% improvement), is predictive of job loss -- even if ACR50 (50% improvement) is later achievable. So, the message there that is not to be missed is that early treatment is essential.

But, there is good news that is not to be missed as well. According to study results published in Arthritis Care & Research (December 2013), compared to 20 years ago, rheumatoid arthritis patients are having an easier time with daily living activities. The results revealed that psychological distress (i.e., anxiety, depressed mood) and physical disability related to rheumatoid arthritis have been halved in the two decades.

Reduced disease activity is getting the credit. Improved treatment options (including biologic drugs), early treatment, and recommendations for regular physical activity are making a difference. Disability is no longer inevitable.

Sources:

Causes of Disability Among US Adults. Centers for Disease Control and Prevention. 10/20/2010.
http://www.cdc.gov/arthritis/data_statistics/national_nhis.htm#disability

Rheumatoid Arthritis. Centers for Disease Control and Prevention. 11/19/2012.
http://www.cdc.gov/arthritis/basics/rheumatoid.htm

Rheumatoid Arthritis: Early Diagnosis and Treatment. Cush, Weinblatt, Kavanaugh. p.54 and p.298. Professional Communications, Inc. Third Edition.

Kelley's Textbook of Rheumatology. Elsevier Saunders. Ninth edition.

Patients With Rheumatoid Arthritis Nowadays Are Less Psychologically Distressed and Physically Disabled Than Patients Two Decades Ago. Arthritis Care & Research. Overman CL, et al. December 2013.
http://onlinelibrary.wiley.com/doi/10.1002/acr.22211/abstract

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