Australian Institute of Health and Welfare (2020) Rheumatoid arthritis, AIHW, Australian Government, accessed 30 June 2022.
Australian Institute of Health and Welfare. (2020). Rheumatoid arthritis. Retrieved from https://pp.aihw.gov.au/reports/chronic-musculoskeletal-conditions/rheumatoid-arthritis
Rheumatoid arthritis. Australian Institute of Health and Welfare, 25 August 2020, https://pp.aihw.gov.au/reports/chronic-musculoskeletal-conditions/rheumatoid-arthritis
Australian Institute of Health and Welfare. Rheumatoid arthritis [Internet]. Canberra: Australian Institute of Health and Welfare, 2020 [cited 2022 Jun. 30]. Available from: https://pp.aihw.gov.au/reports/chronic-musculoskeletal-conditions/rheumatoid-arthritis
Australian Institute of Health and Welfare (AIHW) 2020, Rheumatoid arthritis, viewed 30 June 2022, https://pp.aihw.gov.au/reports/chronic-musculoskeletal-conditions/rheumatoid-arthritis
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Rheumatoid arthritis is an autoimmune disease where the body’s immune system attacks its own tissues. Rheumatoid arthritis can affect anyone at any age, and may cause significant pain and disability.
Rates of rheumatoid arthritis are slightly higher for women (2.3%) than men (1.5%)
About 456,000 Australians (1.9% of the total population) have rheumatoid arthritis
In 2017–18, there were 12,045 hospitalisations for rheumatoid arthritis, a rate of 43 per 100,000 persons
Rheumatoid arthritis is most common in people aged 75 years or over
At present there is no cure for rheumatoid arthritis. The Australian Models of Care for the management of the disease focus on early diagnosis, early management, and coordination of multidisciplinary care needs (Speeran et al. 2014; Arthritis Australia 2014). The goal of rheumatoid arthritis treatment is to stop inflammation (put the disease in remission), relieve symptoms, prevent joint and organ damage, reduce complications and improve physical function. Early treatment for rheumatoid arthritis is aggressive in order to stop inflammation as soon as possible (Arthritis Australia 2014).
Medications are primarily used to treat rheumatoid arthritis, however physical therapy and surgery can also be used.
Treatment for rheumatoid arthritis has improved dramatically over the past 20 years, with new medicines now very helpful for people, particularly in the early stages of the disease.
Simple analgesics (such as paracetamol) may be used for pain management. Based on the patient’s needs, doctors may also prescribe other medications to manage pain and/or stiffness, such as fatty acid supplements, nonsteroidal anti-inflammatory drugs (NSAIDs), COX-2 inhibitors and low dose corticosteroids (RACGP 2009).
Disease-modifying anti-rheumatic drugs (DMARDs), biologic disease-modifying anti-rheumatic drugs (bDMARDs), and corticosteroids may slow disease progression (Nam et al. 2014, RACGP 2009). Corticosteroids and DMARDs are typically prescribed and monitored by specialist rheumatologists and require close medical monitoring to ensure effectiveness and to minimise side effects (RACGP 2009). Evidence suggests initiation of aggressive treatment with DMARDs within 12 weeks of symptom onset is associated with less joint destruction and a higher chance of achieving DMARD-free remission as compared with a longer delay in assessment (Van der Linden 2010).
bDMARDs are specialised immunosuppressant medications that have been shown to halt or slow the disease process sufficiently to reduce the joint destruction and disability associated with early rheumatoid arthritis (Nam et al. 2014). bDMARDs are also used for other autoimmune conditions such as juvenile arthritis, psoriatic arthritis and Crohn's disease.
Treatment options for rheumatoid arthritis, including bDMARDs are available through the Pharmaceutical Benefits Scheme (PBS) and Repatriation Pharmaceutical Benefits Scheme (RPBS) (AIHW 2013).
Maintaining a healthy and active lifestyle is an important management strategy in rheumatoid arthritis. Low-impact physical activity can assist in reducing inflammation, increasing and maintaining mobility and strengthening muscles around affected joints (Cooney 2011). A physiotherapist can prescribe an exercise program to assist in the management of rheumatoid arthritis.
Joint replacement surgery can relieve pain and restore function to joints severely damaged due to rheumatoid arthritis.
Treatment of rheumatoid arthritis often begins with the patient visiting a general practitioner (GPs). This is an important step in the treatment of rheumatoid arthritis because it is optimal for inflammation to be managed early on to reduce the chances of joint damage occurring (Speerin et al. 2014) and improve long-term outcomes (Bakker et al. 2011). GPs often conduct initial assessment and diagnosis of rheumatoid arthritis. The time from onset of rheumatoid arthritis symptoms and referral to a specialised rheumatologist for treatment needs to be as efficient as possible to improve long-term treatment outcomes (Nam et al. 2014). The RACGP recommends GPs complete diagnosis of rheumatoid arthritis as soon as possible and refer patients to a rheumatologist if joint swelling persists beyond 6 weeks (RACGP 2009).
Treatment of rheumatoid arthritis is usually managed by general practitioners in partnership with rheumatologists and allied health professionals (such as physiotherapists) and centres on managing pain, reducing inflammation and joint damage, and preventing loss of function.
Severe disease however may require hospitalisation to relieve pain and restore function to damaged joints.
Data from the AIHW National Hospital Morbidity Database (NHMD) show that, in 2017–18:
Source: AIHW National Hospital Morbidity Database (Data table).
Between 2008–09 and 2017–18, the age-standardised hospitalisation rate for rheumatoid arthritis peaked in 2015–16 at 50 per 100,000, compared with 43 per 100,000 in 2017–18. The hospitalisation rate peaked at 73 per 100,000 for females and at 26 per 100,000 for males, in 2015–16 (Figure 2).
Note: Rates are age-standardised to the Australian population as at 30 June 2001.
In 2017–18, a total of 20,807 procedures were performed in rheumatoid arthritis hospitalisations. Administration of pharmacotherapy (40%), generalised allied health interventions (including physiotherapy, occupational therapy and dietetics) (25%) and cerebral anaesthesia (5.9%) were the most common groups (blocks) of procedures for rheumatoid arthritis hospitalisations.
For more information on the treatment and management of rheumatoid arthritis, see the Australian Rheumatology Association and Arthritis Australia
AIHW (Australian Institute of Health & Welfare) 2010. Medication use for arthritis and osteoporosis. Arthritis series no. 11. Cat. no. PHE 121. Canberra: AIHW.
AIHW 2013. A snapshot of rheumatoid arthritis. Bulletin no. 116. Cat. no. AUS 171. Canberra: AIHW.
Arthritis Australia 2014. Time to move: rheumatoid arthritis, a national strategy to reduce a costly burden. Sydney: Arthritis Australia.
Bakker M, Jacobs J, Welsing P, Vreugdenhil S, van Booma-Frankfort C, Linn-Rasker S et al. 2011. Early clinical response to treatment predicts 5-year outcome in RA patients: follow-up results from the CAMERA study. Annals of the rheumatic diseases 70 (6):1099–103.
Cooney JK, Law R-J, Matschke V et al. 2011. Benefits of exercise in rheumatoid arthritis. Journal of aging research 2011.
Nam JL, Ramiro S, Gaujoux-Viala C et al. 2014. Efficacy of biological disease-modifying anti-rheumatic drugs: a systematic literature review informing the 2013 update of the EULAR recommendations for the management of rheumatoid arthritis. Annals of the Rheumatic Diseases 73 (3):516–528.
RACGP (The Royal Australian College of General Practitioners) 2009. Clinical guideline for the diagnosis and management of early rheumatoid arthritis. Melbourne: RACGP.
Speerin R, Slater H, Li L et al. 2014 (in press). Moving from evidence to practice: Models of care for the prevention and management of musculoskeletal conditions, Best Practice & Research Clinical Rheumatology 28(3) 479-515.
Van der Linden MPM, le Cessie S, Raza K et al. 2010. Long-term impact of delay in assessment of patients with early arthritis. Arthritis and Rheumatism 62 (12): 3537–3546.
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