Arthritis Patients Benefit From Aggressive Treatment

Study finds far fewer hospitalizations than 2 decades ago

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HealthDay Reporter

MONDAY, April 5, 2004 (HealthDayNews) -- An aggressive strategy in the treatment of rheumatoid arthritis is paying off with fewer hospitalizations and better quality of life for people with the joint-destroying disease, a study finds.

Rheumatoid arthritis is far different from osteoarthritis, the wear-and-tear condition that erodes bones over the years and decades. Rheumatoid arthritis is an autoimmune condition that can occur at any age, as the body's defense system somehow begins to attack its own tissue.

Until about two decades ago, doctors would treat the early stages of rheumatoid arthritis primarily with painkillers, saving such drugs as methotrexate that attack the immune condition itself for later, when joint destruction became apparent. Then, as the safety of these newer drugs became more apparent, rheumatologists began using them much earlier, as first-line treatment.

The result has been a substantial reduction in hospitalizations for rheumatoid arthritis complications, says a report in the April issue of the journal Arthritis and Rheumatism. It was written by Dr. Michael M. Ward, a rheumatism specialist at the National Institute of Arthritis and Musculoskeletal and Skin Diseases.

Looking at records of California hospitals, Ward found that the overall rate of hospitalization for rheumatoid arthritis was lower between 1998 and 2001 than from 1983 to 1987. The results included a 33 percent reduction in hospitalization for vasculitis, which is inflammation of blood vessels, and a 71 percent reduction in surgery for removal of spleens damaged by the disease.

Some changes are just becoming evident, the study shows. The number of knee-replacement operations increased during the earlier years of the study, then dropped by 10 percent between 1998 and 2001.

"This is just one of a number of studies done recently to look at this question," Ward said. "Several other studies that followed individual patients in clinics, looking at physical function and symptoms, also reported benefits."

The study was designed to test the possibility that a lower rate of hospitalizations was due to cost-cutting efforts rather than improved treatment, Ward said.

The results clearly point to "broader and more widespread use of newer medications," he added.

There's reason to hope for even better news in the years ahead, said Dr. David Karp, chief of the rheumatic diseases division at the University of Texas Southwestern Medical Center and medical advisor to the Arthritis Foundation.

"The database trails actual medical practice, which trails advances in medical practice," Karp said. "This study takes place over almost two decades. The earlier part now reflects changes in care that we now regard as pedestrian, small steps that at one time were thought to be radical changes."

Given greater use of more powerful drugs early in the course of the disease, Karp said, "we hardly ever admit patients for rheumatoid arthritis any more."

It will take some time for the latest results to show up in statistics, Karp said, adding, "We'll need to look back at 2004 in 2114 to be sure."

But the basic change in strategy is firmly established, he said.

"The hope now is to attack even earlier with even stronger medications," Karp said. "We have been all too slow to come to the realization that we need to treat immune system diseases such as rheumatoid arthritis like oncologists treat cancer."

More information

You can learn about advances in rheumatoid arthritis treatment from the Arthritis Foundation. For more on the disease, visit the National Library of Medicine.

SOURCES: Michael M. Ward, M.D., investigator, National Institute of Arthritis and Musculoskeletal and Skin Diseases, Besthesda, Md.; David Karp, M.D., chief, rheumatic diseases division, University of Texas Southwestern Medical Center, Dallas; April 2004 Arthritis and Rheumatism

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