Rheumatoid arthritis has no cure, but treatments exist

Disability insurance may be helpful for patients who later have to leave the workforce
By Prepared by the AVMA Group Health and Life Insurance Trust
Published on
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Despite affecting more than 2.5 million Americans and being the subject of active global research, rheumatoid arthritis remains a mystery in terms of causes, risk factors, and a cure.

Rheumatoid arthritis, which affects more women than men, can occur at any age, although it most often develops between the ages of 40 and 50. The autoimmune disease causes painful, chronic inflammation of the joints and can cause inflammation of the tissue around the joints as well as other organs.

The joint damage caused by rheumatoid arthritis can be debilitating and disfiguring, resulting in pain, loss of function, and permanent disability. But the impact of the disease goes beyond physical. Quality of life declines as patients find it difficult or impossible to go about their daily activities.

In fact, an estimated 50 percent of patients with rheumatoid arthritis are forced to leave the workforce within 10 years of onset—often long before reaching retirement—according to a report appearing in the European Journal of Health Economics last year. As a result, many patients already battling a devastating disease face an uncertain financial future because of lost income. Disability insurance may help in this situation.

Treatment, which is limited primarily to controlling pain and slowing the progression of the disease, is costly. The global market for treatments for rheumatoid arthritis is expected to reach $27 billion in 2015, according to Espicom market research, up from $11.6 billion in 2007. Most of the spending goes toward nonsteroidal anti-inflammatory drugs, glucocorticoids, disease-modifying anti-rheumatic drugs, and biologic therapies.

The AVMA Group Health and Life Insurance Trust paid $534,807 in claims related to rheumatoid arthritis in 2008, up from $505,748 in 2007. The figures include $350,000 to $400,000 per year, or about $4,250 per patient, for medications covered by the Trust's prescription drug benefit. Patients without insurance can potentially spend more than $5,000 per year out of their own pocket just for medications.

Symptoms, diagnosis, and progression

Although infectious agents such as viruses, bacteria, and fungi have long been suspected of causing rheumatoid arthritis, no scientific evidence has proved this hypothesis.

Some scientists believe that the tendency to develop rheumatoid arthritis may be genetic, whereas others believe environmental factors and certain infections trigger the immune system to attack the body's own tissues, resulting in the inflammation in the joint lining that characterizes the disease. Recent findings also indicate that smoking may increase the risk of developing rheumatoid arthritis.

Among the most common symptoms of rheumatoid arthritis are joint pain and swelling, joints that are tender to the touch, red and puffy hands, firm bumps of tissue under the skin on the arms, fatigue, morning stiffness that lasts at least half an hour, fever, and weight loss.

Diagnosis of the disease typically begins with a physical examination and blood tests to detect any elevation in the erythrocyte sedimentation rate, which indicates the presence of an inflammatory process in the body. Blood tests also may measure rheumatoid factor and anti-cyclic citrullinated peptide antibodies, and an analysis of joint fluid may be conducted to help rule out other diseases or conditions.

Rheumatoid arthritis progresses in three stages:

  1. The synovial lining swells, causing pain, stiffness, warmth, redness, and swelling around the affected joint.
  2. Rapid cell division and growth take place, causing the synovium to thicken.
  3. Inflamed cells release enzymes that may digest bone and cartilage, often causing the involved joint to lose its shape and alignment, resulting in more pain and loss of movement.

Early rheumatoid arthritis tends to affect the small joints in the wrists, hands, ankles, and feet. As the disease progresses, joints in the shoulders, elbows, knees, hips, jaw, and neck also can be affected. Over time, the symptoms of rheumatoid arthritis can vary in severity and even go into temporary remission. Nevertheless, there is no cure for the disease.

Early, aggressive treatment is key

Early diagnosis and proper treatment of rheumatoid arthritis are crucial to limiting joint damage and reducing loss of mobility. Treatment varies, depending on the severity of the disease, lifestyle factors, and other medical conditions, but it is typically focused on medications to relieve pain and inflammation, stop or slow joint damage, and improve joint function (see sidebar).

In severe cases or when rheumatoid arthritis does not respond to medication, surgery may be an option to repair or replace damaged joints, reduce pain, and correct deformities. Among the most common surgical procedures are total joint replacements, tendon repairs, and removal of the synovium.

GHLIT disability insurance may help veterinarians meet financial obligations if they become unable to work because of rheumatoid arthritis or other covered disabling illnesses or accidents. Additional information about the Trust's insurance program—including exclusions, limitations, rates, eligibility, and renewal provisions—is available by calling (800) 621-6360. GHLIT is underwritten by New York Life Insurance Co.

The following medications are among the most effective for the treatment of rheumatoid arthritis:

Nonsteroidal anti-inflammatory drugs

Over-the-counter and prescription-strength NSAIDs, including ibuprofen and naproxen sodium, help relieve pain and reduce inflammation. Possible adverse effects with long-term, high-dosage use include ringing in the ears, gastric ulcers, heart problems, stomach bleeding, and liver and kidney damage.

Corticosteroids

Corticosteroid medications reduce inflammation and pain while slowing joint damage. They may become less effective with long-term use and can carry serious adverse effects, including easy bruising, thinning of bones, cataracts, weight gain, a rounding of the face, and diabetes.

Disease-modifying anti-rheumatic drugs

DMARDs are typically prescribed in the early stages of rheumatoid arthritis to slow the disease and limit joint and tissue damage.

Immunosuppressants

Immunosuppressants help "tame" the immune system. Some also attack and eliminate cells associated with rheumatoid arthritis. Potentially serious adverse effects include increased susceptibility to infection.

TNF-alpha inhibitors

TNF-alpha is a cytokine that acts as an inflammatory agent in rheumatoid arthritis. TNF inhibitors, such as etancercept and adalimumab, target or block this cytokine to help reduce pain, morning stiffness, and tender or swollen joints—and also may stop progression of rheumatoid arthritis. Potential adverse effects include injection-site irritation, worsening of congestive heart failure, blood disorders, lymphoma, demyelinating diseases, and increased risk of infection.