Pharmacy Times
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RA Patients Have Poorer Self-image

Patients with rheumatoid arthritis (RA) can experience physicaldeformities, especially of the hands and feet. A study thatexamined the relationship between physical appearance concernsand psychological distress in RA patients shows thatwomen with RA have poorer body self-images than womenwithout the disease. The results of the study were published inthe March 2007 issue of Arthritis Care & Research.

The study, which took place at the University of Sydney in NewSouth Wales, Australia, included 157 patients with lupus, newlydiagnosed RA, or chronic RA. The patients with RA completed adifferent set of questionnaires regarding their health than thosewith lupus because of the disparities between the conditions.The researchers looked at disability, health-related quality of life,psychological distress, and coping strategies. The RA patientsalso underwent joint assessments. The results showed that 30%of the patients with chronic RA and 34% with newly diagnosedRA reported that they felt unattractive because of their disease.They found that both appearance and physical disability are predictiveof depression in these patients. The researchers thinkthat, because depression is linked to future disability, targetingappearance concerns of RA patients may improve their mood,which could lead to better health outcomes.

Heavy Patients Suffer More Surgery Complications

A study from the Geneva University Hospital in Switzerlandshowed that obese patients are more likely to have a higherrate of total hip replacements due to a greater incidence of hiposteoarthritis. The study evaluated the effects of obesity oncomplications and outcomes following total hip replacementsand learned whether the results differed between obesewomen and men. The findings were published in the March2007 issue of Arthritis Care & Research.

The researchers looked at information on patients whounderwent total hip replacements between March 1996 andJuly 2005 at the hospital. Of the 2495 surgeries, 589 were performedon obese patients, comprised of more men thanwomen. The researchers evaluated the incidence of infection,dislocation, and revision (having to redo the surgery), as well asquality of life, satisfaction, and general health 5 years after thereplacement.

The results showed that obesity was associated with a substantiallyhigher risk for infection in women, led to more dislocationin women, and resulted in more revisions due to septicloosening caused by infection. After 5 years, obese womenreported moderately lower functional outcomes and slightlyless satisfaction, mostly due to a higher rate of complications.

Evaluating the Cost of JIA

Juvenile idiopathic arthritis (JIA) is the most common rheumaticdisease that afflicts children, yet little is known about itsimpact on the economy. A study conducted by the McGillUniversity Health Centre in Montreal, Quebec, Canada, examinedthe direct medical costs of caring for children with JIA andfound those costs to be substantial.

Researchers looked at 155 children with JIA and 181 controlsfrom 2 hospitals in Montreal and Vancouver. The parents of theparticipants were asked to fill out a questionnaire about medicationuse and health service access during the prior 3months, without specifying any exact disease. The parentswere also queried about time lost from work and how manydays the children missed school. The researchers noted thatparents of children with JIA had higher costs related to specialists,health care professionals, and diagnostic tests, and the differencein annual direct medical costs for the JIA group was$1686 more than for the control group.

The researchers stated, "Ongoing active inflammation and theconsequent joint damage have a significant impact on the abilityof an individual to be a productive member of society,"and that"decisions regarding access to therapies should be considered interms of overall cost-benefit ratios."The findings were publishedin the February 2007 issue of Arthritis Care & Research.

Anticipating RA Can Help Postpone Pain

Researchers at the Leiden UniversityMedical Center in the Netherlands believethat they may have found a new way ofpredicting whether patients with arthriticsymptoms will actually progress torheumatoid arthritis (RA). The best strategyagainst crippling joint damage from RAis very early, aggressive medicinal treatment.The drugs tend to have undesirableside effects, however; the researchers'goal is to determine which patients willactually need the therapy in order tospare those who do not from the adverseeffects.

The researchers looked at 570 patientsat the Leiden Early Arthritis Clinic withundifferentiated arthritis, 177 of whomprogressed to RA within a year. Theresearchers were able to identify 9 variablesand 3 laboratory tests by using acombination of questionnaires, physicalexams, and blood samples. Using a 14-point predictive score based on theirassessments, with 0 being the lowest likelihoodof progression to RA, the researchersfound that none of the patientswho scored 3 or less developed RA, whileall those who scored 11 or higher did. Thefindings were published in the February2007 issue of Arthritis & Rheumatism.

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