RA symptoms invisible but harmful, mortality increases with RA, plus 6 more highlights from recent RA studies of interest to primary care.
1. Now You See the RA Symptoms, Now You Don’t.
The initial symptoms of RA often are invisible to others, a survey showed. Persons who had RA noted feeling stigmatized for often “not looking sick.” Before receiving a diagnosis, 76% of respondents saw at least 3 doctors and 54% had 5 or more office visits. The average time between initial symptoms and RA diagnosis was 4 years.
2. RA Symptoms Hurt Quality of Life.
Survey respondents reported painful joints, 87%; joint stiffness, 68%; both, 64%; fatigue, 60%; and general stiffness, soreness, or aching throughout the body, 58%; 70% reported that RA symptoms lowered overall quality of life: ability to exercise or take part in physical activity, 77%; ability to perform family/household duties, 71%; sleep, 68%; and ability to work, 62%.
3. More Mortality with RA.
Mortality among patients with RA was 54% higher than in the general population in a Dutch study. More than 1 life-year was lost over 15 years. Mortality tended to decrease over time (2% annually). Mortality was higher for cardiovascular, respiratory, musculoskeletal, and digestive diseases.
4. Fragility Fractures Linked with Cardiovascular Risk.
Fragility fractures in women and men who have RA are associated with a significantly increased risk of cardiovascular disease (CVD) events. Both fractures and CVD events have been reported to contribute to excess morbidity and mortality. Clinicians are advised to target these patients for further screening and preventive strategies for CVD.
5. Short-term MRI Predicts Long-term X-ray Changes.
In patients with RA, early changes in joint damage and inflammation detected with MRI predict changes in joint damage evident on subsequent x-ray films. Progression of MRI erosion scores at Weeks 12 and 24 predicted progression of x-ray erosions at Weeks 24 and 52, and MRI osteitis scores were similarly predictive. MRI changes in synovitis at Weeks 12 and 24 also predicted progression of x-ray joint damage at Weeks 24 and 52.
6. TNF Inhibitors Lower MI Risk in Patients with RA.
The risk of myocardial infarction is lower in patients with RA receiving tumor necrosis factor (TNF) inhibitors than in those receiving synthetic disease-modifying antirheumatic drug therapy over the medium term. The lower risk might be attributed to a direct action of TNF inhibitors on the atherosclerotic process or better overall disease control.
7. Physical Activity May Ease the Chronic Pain of RA.
An overview of Cochrane Reviews on the effectiveness of physical activity and exercise interventions in adults with chronic pain included those with RA, osteoarthritis, and fibromyalgia. There were some favorable effects in reduction in pain severity and improved physical function, mostly of small-to-moderate effect. The effects for psychological function and quality of life were variable
8. RA Linked with Gum Disease.
(Aa), a periodontal pathogen, has been identified as a candidate bacterial trigger for RA, providing a link between periodontal infection and autoimmunity. A new study proposes a model in which Aa induces activation of citrullinating enzymes in neutrophils and thus autoantigen production.
RA symptoms invisible but harmful, mortality increases with RA, fragility fractures linked with cardiovascular risk-we offer these and other highlights of recent surveys and studies of interest to primary care physicians.Scroll through the slides above for key findings. Original sources are below.Â Sources1. Now You See the RA Symptoms, Now You Don’t2. RA Symptoms Hurt Quality of Life3. More Mortality with RA4. Fragility Fractures Linked with Cardiovascular Risk5. Short-term MRI Predicts Long-term X-ray Changes6. TNF Inhibitors Lower MI Risk in Patients with RA7. Physical Activity May Ease the Chronic Pain of RA8. RA Linked with Gum Disease