Patient Education For Rheumatoid Arthritis

[Kerby Reynolds]

Rheumatoidarthritis or RA is a form of inflammatory polyarthritis that can lead to joint destruction, deformity, and loss of function. Swelling of the small joints, especially in the hands and feet, is the hallmark of the disease, but most joints in the body can become affected. In addition to the joints, other manifestations of the disease can be seen including subcutaneous nodules, eye inflammation, lowering of the white blood count, and lung disease. Frequent symptoms include fatigue and joint stiffness, especially in the morning and after prolonged periods of rest.

Without appropriate treatment, chronic pain, disability, and excess mortality are unfortunate outcomes of this disease. RA causes joint damage in 80% to 85% of patients, with the brunt of the damage occurring during the first 2 years of the disease. Left untreated, the risk of mortality is increased. Untreated people with RA are twice as likely to die compared with unaffected people the same age.

Common causes of mortality in RA include cardiovascular disease, which accounts for approximately one third to one half of RA-related deaths, and infection, which is associated with approximately one quarter of such deaths. RA is also known to be associated with higher risks for lymphoma, anemia, osteoporosis, and depression.

All information contained within the Johns Hopkins Arthritis Center website is intended for educational purposes only. Physicians and other health care professionals are encouraged to consult other sources and confirm the information contained within this site. Consumers should never disregard medical advice or delay in seeking it because of something they may have read on this website.

With respect to patient education, the last five decades have seen an evolution of the patient/clinician relationship dynamics [20], where the clinicians have moved from the position of power as the sole knowledge owners and transmitters, and patients from an inferior position of passive recipients to a more progressive dynamic of shared decision-making. The current standard is patient-centred care which is responsive to individual patient preferences, needs, and values. In the same vein, it is hoped that needs-based approach in patient education will be the way forward.

A new study lead by Felipe Andrade, M.D., Ph.D. from the Johns Hopkins University Division of Rheumatology provides new evidence that a bacterium known to cause chronic inflammatory gum infections also triggers the inflammatory autoimmune response also found in the joints of patients with the chronic, joint-destroying autoimmune disease, rheumatoid arthritis (RA). These new findings have important implications for the prevention and treatment of RA.

Among different periodontal bacteria, the study identified that only one called Aggregatibacter actinomycetemcomitans (Aa) could trigger hypercitrullination in human white blood cells, the major source of citrullinated proteins in RA. Aa causes hypercitrullination by secretion of a toxin called leukotoxin A (LtxA) that pokes holes in white blood cells as a self-defense strategy to kill host immune cells. Further studies demonstrated that almost half of the patients with RA have evidence of infection by Aa, compared with 11% of healthy individuals. More strikingly, exposure to Aa was an important factor for production of antibodies to citrullinated proteins in patients with genetic susceptibility to RA.

Current treatment with steroids, biologic drugs and physical therapy are effective for reducing or slowing the crippling and painful joint deformities in some, but not all patients with RA. This study sheds new light on the longstanding relationship between gum disease and RA by identifying hypercitrullination as a common process that unites these two seemingly unrelated conditions. Learning more about how this process starts and causes the immune system to attack proteins in the joint may lead to new ways to treat and even prevent RA in the future.

Erika Darrah, Ph.D. is an Assistant Professor of Medicine in the Johns Hopkins University Division of Rheumatology with an interest understanding the mechanisms that drive the development of rheumatic diseases.

All information contained within the Johns Hopkins Division of Rheumatology website is intended for educational purposes only. Physicians and other health care professionals are encouraged to consult other sources and confirm the information contained within this site. Consumers should never disregard medical advice or delay in seeking it because of something they may have read on this website.

Explore our library of patient education resources. These Lilly-created materials are embedded with the principles of health literacy and designed to support effective interactions with your patients.

Rheumatoid arthritis is a chronic inflammatory disorder that can affect more than just your joints. In some people, the condition can damage a wide variety of body systems, including the skin, eyes, lungs, heart and blood vessels.

The inflammation associated with rheumatoid arthritis is what can damage other parts of the body as well. While new types of medications have improved treatment options dramatically, severe rheumatoid arthritis can still cause physical disabilities.

Ms. Williams: Dr. Nisha Manek says it happens when the immune system becomes deregulated. You see, the joint capsule has a lining of tissue called the synovium. The synovium makes fluid that keeps joints lubricated. When you have rheumatoid arthritis, your immune system sends antibodies to the synovium and causes inflammation. This causes pain and joint damage, especially in small joints in the fingers and wrists. But it can affect any joint.

Ms. Williams: Dr. Manek says if you have pain, swelling and stiffness in your joints that comes and goes and is on both sides of your body, see your doctor to see if it is rheumatoid arthritis.

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Rheumatoid arthritis is an autoimmune disease. Normally, your immune system helps protect your body from infection and disease. In rheumatoid arthritis, your immune system attacks healthy tissue in your joints. It can also cause medical problems with your heart, lungs, nerves, eyes and skin.

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A controlled study of education-support groups for patients with rheumatoid arthritis showed that participation increased patients' knowledge about their disease (P less than 0.05) and improved some patients' perceptions of the adequacy of their families' attitudes and behavior. The groups had little effect on the patients' ability to cope with arthritis or on their compliance with prescribed treatment. Some participants felt threatened by the thought of meeting another patient with more severe rheumatoid arthritis than their own. This finding suggests that group leaders should facilitate open discussion of such emotional concerns, eg, fear and depression, that admixtures may generate.

Objective: The present study was undertaken to evaluate the efficacy of 2 educational tools for patients with rheumatoid arthritis (RA) by comparing a newly developed video tool, including storylines and testimonials, combined with a written booklet to the same written booklet alone.

Methods: We conducted a randomized controlled trial. Our primary outcome was disease knowledge. Secondary outcomes were decisional conflict, self-efficacy, effective health care management, and satisfaction. Outcomes were measured before and after reviewing the materials, and 3 and 6 months later. Linear mixed-effects models were performed to evaluate changes over time.

Results: In total, 221 participants received an educational video and booklet (n = 111) or a booklet alone (n = 110). The mean age was 50.8 years, mean disease duration was 4.8 years, 85% were female, and 24% had limited health literacy levels. Within groups, most outcomes improved between baseline and follow-up, but there were no statistically significant differences across groups. Patients receiving the video and booklet were more likely than those receiving the booklet alone to rate the presentation as excellent for providing information about the impact of RA, medication options, evidence about medications, benefits of medication, and self-care options. Factors significantly associated with greater improvements in knowledge and decisional conflict from baseline to 6 months included limited health literacy, lower educational level, and shorter disease duration.

Conclusion: Regardless of the delivery method, outcomes were improved up to 6 months after educational materials were delivered. Our findings support the implementation of self-administered educational materials in clinical settings, as they can result in sustained improvements in disease knowledge and decisional conflict.

The symptoms can worsen over time and spread to more joints including the knees, elbows or shoulders. RA can make it hard to perform daily activities like writing, holding objects with the hands, walking and climbing stairs.

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