Rheumatoid Arthritis: Which Patients Do Best?
The Roles of Patient Knowledge
and Motivation, Compliance, and Self-Management in Outcome
Medical Author: William C. Shiel Jr., MD, FACP, FACR
Medical Editor: Catherine Burt Driver, MD
Health care is an evolving art-science. Long gone are the days when patients
with chronic diseases simply arrive at a doctor's office and are told a
diagnosis, given a prescription, and asked to return in so many weeks or months
without any discussion or transmission of information about the pathophysiology
of the illness, treatment options, prognosis, or methods of monitoring for drug
toxicity. This is particularly true in the management of rheumatoid arthritis.
The optimal management of rheumatoid arthritis begins with patient education
about how the disease occurs and what damage it can cause, as well as an
overview of the symptoms, diagnosis, and treatment options. Consequently, there
are major advantages for patients who have the capability of understanding a
variety of new concepts and are motivated to participate in the treatment
decisions and monitoring of both the rheumatoid disease and for potential
toxicities of treatments.
Consistent with the concept of "better understanding of the illness leads to
better outcomes," research studies have documented better outcomes for those
patients with rheumatoid arthritis who come from higher socioeconomic
backgrounds. It is felt that patients who are better educated about the
rheumatoid condition are empowered to be more comfortable with confronting the
various methods of treating and monitoring the disease. Moreover, they will be
more motivated to monitor appropriately the consequences of treatments, such as
being obligated to regularly test their blood to be confident that toxicities
are detected early.
It is also felt that a better understanding of the adverse consequences of
not treating the rheumatoid arthritis can greatly minimize the risk of these
consequences, including joint destruction, deformity, disability, as well as
increased risk for disease in internal organs. These risks are precisely why
compliance with a treatment program is so very important. Better compliance and
being consistent with an agreed upon treatment program has clearly been shown to
lead to better outcomes -- both in terms of beneficial impacts on the disease as
well as minimizing side effects of treatments.
Finally, many aspects of modern-day treatment of rheumatoid arthritis require
patient self-management of the disease. Whether it is simply taking oral
medications as prescribed regularly, learning to give and administering
self-injections of medications, getting regular blood and/or
urine testing to
monitor the disease and toxicities of medications, or engaging in progressive
exercise regimens, patients play a central role in management. Each of these
treatment issues can be essential for optimal outcomes and are completely in the
hands of the patient. The current treatment of rheumatoid arthritis mandates
that patients take responsibility for their health by directly participating in
many levels of their care. The doctor-patient relationship has never been so
well exemplified as now in the treatment of rheumatoid arthritis.
REFERENCE:Last Editorial Review: 1/19/2012 3:08:20 PM
Klippel, John H., et al., eds. Primer on the Rheumatic Diseases. 13th ed. New York: Springer and Arthritis Foundation, 2008.