Rheumatoid arthritis(RA) is an autoimmune inflammatory disorder in which the body’s tissue is attacked by its own immune system. Due to the nature of this disorder the joints in the hands and feet, for example, can be affected; inflammation causes painful swelling to occur. Long periods of inflammation can cause destruction of bone and disfigurements of joints to occur. It is vital that early diagnosis be made, and a treatment plan begin, as there is no cure for this disorder. While this condition can begin at any age, women are two-three times more likely to get it than men. In 2008 it was estimated that RA affected 1.3 million adults. Studies shows that certain genes such as HLA (human leukocyte antigen) as well as environmental factors such as smoking may make arthritis worse. Rheumatologists are able to perform certain blood tests to see if the patient suffers from RA. Financial costs of treatment may burden the patient. Diclofenac, a non-steroidal anti-inflammatory medication may run the patient an average retail price of $80.01. It is imperative that the patient be able to price shop for the best prescription prices and plans especially if insurance is an issue. This paper will further examine the history, causes, financial costs, diagnosis, treatment, and prognosis of this disorder. While there is no cure for RA early intervention is vital to the treatment, prognosis, and overall financial costs in the life of the patient. Future research in the biotechnology field may prove useful in finding a cure and cause for RA.
Keywords: arthritis, inflammation, prognosis, treatment, causes, autoimmune, joints.
Rheumatoid Arthritis: An Investigation of An Autoimmune Disorder
“Rheumatoid arthritis, or RA, is an autoimmune and inflammatory disease, which means that your immune system attacks healthy cells in your body by mistake, causing inflammation (painful swelling) in the affected parts of the body” (Center for Disease Control and Prevention CDC 2017). Normally the immune system safeguards the body from invasion; fighting off viruses and bacteria. However, in the case of RA, the immune system does not function properly. Instead the body begins to attack its own self; aiming at tissues such as the synovial membrane, pericardium, and pleura (Torpy 2011).
Historically, rheumatoid arthritis has not always been a well-known disorder to physicians. Entezami, Fox, Clapham, and Chung, suggest that the earliest acknowledgment of RA is found in a dissertation from the year 1800 (2011). The authors go on to discuss the findings of a 28-year-old resident physician named Augustin Jacob Landré-Beauvais. During his time at the Saltpetriere asylum in France Landre-Beauvais found that patients suffered from symptoms of what it now known as RA. His dissertation, while some areas were wrong, laid the pavement for upcoming research for rheumatoid arthritis (Entezami, Fox, Clapham & Chung 2011). This acknowledgment of the symptoms of the disease dating back to the 1800s means that RA may be a condition that has affected humans for quite some time. As previously noted Landre-Beauvais laid the pavement for future research for rheumatoid arthritis; this would prove useful for physician Alfred Garrod in the 19th century. Entezami et al. asserts, “He found an excess of uric acid in the blood of patients suffering from gout, but not in the blood of patients with other forms of arthritis.” (2011). Both Landre-Beauvais and Garrod made important contributions in the discovery of what is now known as rheumatoid arthritis. Today, research is still underway to discover more about this disorder.
Statistics of Rheumatoid Arthritis
Damage done to the body of the patient who suffers from RA is a result of the inflammation caused by the immune response. However, there currently is no known explanation as to why the immune system attacks its own body in this way. Therefore, at this moment there is no known specific cause for RA. That said, researchers have made mention to aspects that put patients at a higher risk for developing RA. According to the Center for Disease Control and Prevention (CDC), “New cases of RA are typically two-to-three times higher in women than in men.” (2017). This statistic puts women at a much higher risk to develop RA than the male population. The CDC goes on to suggest that rheumatoid arthritis prevails with age, however can occur during any point in life (2017). In 2008 it was estimated that “RA affected 1.3 million adults” (Helmick et al. 2008). Among these adults, the CDC acknowledges that the “certain genes such as the human leukocyte antigen (HLA) genotype” make individuals at risk for RA (2017). This factor can be combined with environmental factors such as smoking and obesity to increase risks (CDC 2017). One can conclude a woman who contains the HLA genotype and smokes may be at extreme risk for a worsened case rheumatoid arthritis.
Financial Costs of Treatment
Financial Cost on the Individual and Family
Financial costs of this disorder to the individual may vary due to circumstances. These circumstances included severity of condition, geographic location, and insurance coverage. The nature of this disorder causes inflammation that destroys a part of the body. Depending upon when this disorder is caught, and treatment to reduce symptoms begins, the patient may have to undergo different procedures. Torpy states, “early treatment with disease-modifying antirheumatic drugs (DMARDs) can help to limit the progression of RA and severe joint damage” (2011). These drugs work to suppress the actions of the immune system to prevent further damage from occurring to the patient’s body (Torpy 2011). A common DMARD is Methotrexate which can cost the patient about $75.83 a month out of pocket (GoodRx). Because this condition causes inflammation it seems natural that an anti-inflammatory be needed as well. Diclofenac Sodium ER, an anti-inflammatory, costs regularly about $80.01 (GoodRx). According to the CDC, “rheumatologists should diagnose RA” therefore one must consider the price of a specialist’s office visit (2017). The rheumatologist will order laboratory tests and x-rays, which will add to the overall costs of treatment (Torpy 2011). If RA is not caught soon enough, and damage continues to occur, cost to treat will only grow, as inflammation will worsen the damage. Torpy claims, “an orthopedic surgeon may be recommended if there is joint damage present” (2010). This adds to the cost because this is yet another specialist office visit who may order his or her own set of x-rays or other diagnostics to be done. Geographic location is important to consider because the price of treatment varies from not only country to country but also city to city. For example, according to Kodjak, “the average price for a knee replacement in the Arizona city is $21,976, about $38,000 less than it would in Sacramento, Calif.” (2016). Of course, one must take into consideration the insurance a patient has versus the out of pocket expenses it takes to treat this condition. If a patient has full coverage it is most likely themselves and their families will suffer no financial hardships to treat this disorder. If they have partial coverage the out of pocket expense goes up. However, if a patient has no insurance coverage the costs to treat this disorder, especially if any joint needs repair or replacement, is likely to go far beyond the financial reach of most individuals and their families.
Financial Cost on Society
RA is a life-long battle for those who have it. It progressively gets worse overtime, meaning that a patients symptoms will also get worse. It is important to take into consideration the patient who has been employed in a labor-intensive job during the course of their lives. One can conclude that this type of employment would add stress on the body that is already inflamed thus influencing the severity of the condition and the overall treatment cost. These patients are ones who may experience a loss of employment as mobility decreases (CDC 2017). If the patient is unable to perform the tasks necessary to complete a job they may seek disability benefits. This would in turn create a financial cost onto society.
Anatomy and Physiology
As previously stated, damage done to the body of the patient who suffers from RA is a result of the inflammation caused by the immune response; this occurs because the body attacks its own tissue and inflammation results. Inflammation of joints occurs in many bodily joints including in the hands and feet. Wilke emphasizes, the importance of treating inflammation stating not doing so “progresses to weakening or destruction of supportive structures, including the associated joint ligaments, tendons, cartilage, and bone.” (2010). It is important to note that damage done to joints due to inflammation is permanent (Whiting et al. 2010). Wilke, goes on the describe the anatomical changes that the patient may see with the formation of rheumatoid nodules affirming they “develop in 20% to 35% of patients” as a product of trauma (2010). One can go back to look at the patient who is working a labor-intensive job that has RA that was previously discussed. They may be at risk of developing these nodules in the areas where joints are afflicted due to trauma on the joints resulting from the repetitive labor intense nature of their jobs. As previously mentioned, there are no known direct cause as to why RA occurs, however there is some evidence that it may be a result of a combination of environmental (smoking and obesity) as well as genetic factors (HLA genotype) (CDC 2017).
Diagnoses, Treatment, and Prognosis
As previously discussed the diagnosing of RA should be performed by a rheumatologist (CDC 2017). Wilke suggests a patient must meet “criteria” in order to be diagnosed with RA; be evaluated to see if they match with the signs and symptoms of rheumatoid arthritis, be physically examined, and have blood tests and x-rays. (2010). Currently there are many blood tests that the rheumatologist can use to reach a conclusive diagnosis of RA. These tests include the rheumatoid factor (RF), cyclic citrullinated peptide (CCP), erythrocyte sedimentation rate (ESR), c-reactive protein (CRP), and the antinuclear antibody (ANA) test (RA Support Network 2017). The findings of these tests as well as the meeting of other criteria’s can aid the rheumatologist is diagnosing the patient with RA. One a clear diagnoses has been met treatment can begin.
Whiting proposes, because of the nature of RA (causing permanent damage) early treatment is vital. (2010). As previously discussed certain medications will come to be a part of the treatment plan for a patient who has been diagnosed with RA. These medications include medications that suppress the immune system to prevent further damage from occurring to the patient’s body called DMARD’s as well as anti-inflammatory medications (Torpy 2011). Torpy goes on to suggest, that the replacement of a joint could be presented to those suffering from RA (2011). Joints may be damaged and may need to be replaced to relieved symptoms associated with RA and improve the quality of life for the patient. Naturally, because smoking is a risk factor, quitting will be beneficial in the treatment plan of the individual (CDC 2017). Torpy further suggests a well-maintained diet and approved exercises can improve “overall well-being” (2011). Due to the rheumatic nodules mentioned previously, it seems important to get an y approved by a rheumatologist before beginning it, as some repetitive or intense exercise may contribute to the formation of the nodules.
RA is chronic, meaning the patient will experience the symptoms over their lifetime. Because there is no known cause of RA the condition cannot be prevented making it imperative that early diagnoses and treatment occur in order to preserve joints tissue for as long as possible. One can conclude that because inflammation causes deterioration in the joints tissue (that is permanent) a patient will have a decrease in mobility that will not get better over time, only worsening. Treatment plans that revolve around the patient must be developed to keep the condition under control and allow the patient to live their lives to their full capabilities (RA Support Network 2016).
With rheumatoid arthritis what normally would add protection the body, causes the body to attack itself, leading to permanent joint tissue damage. Due to this permanent nature early diagnoses and treatment is imperative to not only the health of the patient but also the overall treatment costs. For the patient without insurance coverage treatment costs may quickly add up, financially burdening some families. While there is no cure for this condition researchers have assessed several risk factors from genetics to environmental factors. Researchers are continuing to try and find a cause and a cure for RA; future discoveries in the biotechnology field may very well lead to this development.