Rheumatoid Arthritis: Which Patients Do Best?

The Roles of Patient Knowledge and Motivation, Compliance, and Self-Management in Outcome

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.

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Klippel, John H., et al., eds. Primer on the Rheumatic Diseases. 13th ed. New York: Springer and Arthritis Foundation, 2008.