The extra-articular impacts of rheumatoid arthritis: moving towards holistic care

Abstract

Although treat-to-target has revolutionised the outcomes of patients with rheumatoid arthritis (RA) there is emerging evidence that attaining the target of remission is insufficient to normalise patients’ quality of life, and ameliorate the extra-articular impacts of RA. RA has a broad range of effects on patient’s lives, with four key “extra-articular” impacts being pain, depression and anxiety, fatigue and rheumatoid cachexia. All of these are seen frequently; for example, studies have reported that 1 in 4 patients with RA have high-levels of fatigue. Commonly used drug treatments (including simple analgesics, non-steroidal anti-inflammatory drugs and anti-depressants) have, at most, only modest benefits and often cause adverse events. Psychological strategies and dynamic and aerobic exercise all reduce issues like pain and fatigue, although their effects are also only modest. The aetiologies of these extra-articular impacts are multifactorial, but share overlapping components. Consequently, patients are likely to benefit from management strategies that extend beyond the assessment and treatment of synovitis, and incorporate more broad-based, or “holistic”, assessments of the extra-articular impacts of RA and their management, including non-pharmacological approaches. Innovative digital technologies (including tablet and smartphone “apps” that directly interface with hospital systems) are increasingly available that can directly capture patient-reported outcomes during and between clinic visits, and include them within electronic patient records. These are likely to play an important future role in delivering such approaches.

Management of Fatigue in Rheumatoid Arthritis

“…Other reviews have provided insights into the effects of pain and psychological factors on fatigue in RA. 78 79…”

Rheumatoid Arthritis: The Impact of Mental Health on Disease: A Narrative Review

“…Pain in RA can be unrelated to joint damage and even occur before the onset of local inflammation and swelling in the synovium [11]. RA patients with a higher degree of pain reported a higher reduction in QoL [18], and a significant relationship between DAS28 score and QoL has been observed [1,20].…”

The Influence of Socio-Demographic Factors, Lifestyle and Psychiatric Indicators on Adherence to Treatment of Patients with Rheumatoid Arthritis: A Cross-Sectional Study

“…This varies from the aged term "compliance" by emphasising the need for agreement. Comorbid mental health problems in patients with RA are associated with reduced adherence to therapy, as well as remission of RA symptoms, impaired quality of life, increased disability and mortality and enlarged health care costs [8,9]. It is considered that enhanced medication adherence could be even more important on health outcomes than advances in medical therapy [10], with a less significant cost burden on healthcare systems [11].…”

“…RA also has extra-articular impacts, like depression and anxiety. The prevalence of depression is approximately double compared to anxiety, estimated to be 38% [8,9]. Depression and anxiety have similar causative factors such as pain, inflammation, and disability, and are frequently found together in patients [8].…”