Rheumatoid arthritis (RA) is an autoimmune disease that affects approximately 1.3 million Americans. In contrast with other types of arthritis, RA impacts all population groups regardless of age, gender or race. However, it is much more prevalent among women than among men--nearly 70 percent of all cases occur in women—and most new diagnoses are made among people between the ages of 40 and 60.
As an autoimmune disorder, RA occurs when a person’s immune system mistakenly identifies the body’s organs and tissues as foreign and begins to attack them. In a functioning immune system, antibodies are carried in the bloodstream and protect the body from diseases. In contrast, a person suffering from RA has antibodies that target joint tissues and organs, often resulting in an inflamed or thickened synovium (tissue lining) and excess synovial fluid (joint fluid).
Although the most frequent indications of RA are joint pain, swelling, inflammation and redness, other physical symptoms may occur, as well. These include fatigue, stiffness, weakness, flu-like symptoms including minor fever, pain muscle pain, loss of appetite, depression, weight loss, anemia, and a decrease in the production of tears and saliva (Sjögren’s syndrome). If RA is left untreated, more serious consequences may occur including damage to the body’s cartilage, bones, tendons and ligaments. These may, in turn, lead to joint deformity or destruction as well as a loss of joint function. People with advanced RA may find it difficult to do basic tasks like turning a doorknob.
While scientists have not yet identified the exact cause of RA, there are a number of factors that may be linked to the disease. Researches have identified genes and family history, lifestyle choices (like smoking) and environmental causes (like viruses) as potential contributors to RA. Moreover, because women suffer from RA at a much higher rate than men, some scientists have argued that the disease may be linked to hormone
RA is not a curable disease, although it may be treated. Most treatment plans include medications to both minimize a person’s immediate discomfort and also to push the disease into remission. The so-called “first-line” or “fast-acting” medications address immediate pain by reducing inflammation and swelling and may include aspirin and corticosteroids. In order to prevent joint destruction and support remission, doctors also recommend “second-line” medications (known as disease-modifying anti-rheumatic drugs, or DMARDs) like Plaquenil, Azulfidine, and Methotrexate. Most patients need a combination of both first-line and second-line drugs to fully combat RA, and many need to change drug programs at least once during their lives.
There are a number of strategies legislators can use to address issues related to RA. First, they can legislate for better and more extensive health insurance coverage, including increased access to combination treatment strategies using various kinds of drugs. Second, given the severe shortage of rheumatologists in the U.S., they can enact policies and solutions, or incentives to promote rheumatology professions for medical students.
Third, they can raise awareness within their communities through high-profile meetings and educational events about RA and its impact on women. Lastly, state legislators can examine the impact of RA on workforce productivity and implement policies to address these issues.
Additional Resources:
Women In Government RA Task Force Policy Recommendations
http://www.medicinenet.com/rheumatoid_arthritis/article.htm
http://www.mayoclinic.com/health/rheumatoid-arthritis/DS00020/DSECTION=2
http://www.nlm.nih.gov/medlineplus/rheumatoidarthritis.html
http://www.arthritis.org/disease-center.php?disease_id=31
Quick Facts:
1. More than five million people worldwide suffer from RA, a chronic autoimmune disease that causes pain, swelling and stiffness, esp. in the joints of the hands, feet and wrists, and often leads to the destruction of joints.
2. Occurs between ages 30 and 50; as disease progresses it dramatically affects the life of older Americans.
3. 75 percent are women new treatments are available and patients should be seen by a physician for evaluation.
4. Causes inflammation & destruction of joints and can lead to significant disability.
5. No known cause, genetic link.
6. More than 100 types of arthritis; RA and OA are most common but are different.
From the CDC (on Arthritis in General):
Why Should State Legislators Be Concerned?
• Someone you know has arthritis. Nearly 46 million Americans (1 in 5 adults) suffer from arthritis. Arthritis cases are expected to increase to an estimated 67 million U.S. adults by 2030.1
• Arthritis is not limited solely to the aging population. Nearly two thirds of people with arthritis are under the age of 65,1 and an estimated 300,000 are children.2
• Arthritis affects women disproportionately. Over 28 million women suffer from arthritis, compared to approximately 18 million men.3
Arthritis Costs the Economy
• Arthritis makes work difficult for millions. Arthritis is the most common cause of disability among Americans. One in 20 Americans between the ages of 18 and 64 has work limitations due to arthritis, and that number rises to 1 in 7 workers in some states.4
• Arthritis disproportionately affects the workforce. Work limitations due to arthritis are most common among older workers, women, African-Americans and individuals with lower education and income.5
• Arthritis treatment is costly. Arthritis and other rheumatic conditions cost nearly $128 billion in 2003 in medical expenses and lost wages. 6 Each year, arthritis results in 750,000 hospitalizations and 36 million outpatient visits.3
What Are the Effects of Arthritis?
• Arthritis refers to a group of over 100 medical conditions. The most common form of arthritis is osteoarthritis, which affects over half of persons over 25 who have arthritis. 7
• Arthritis most commonly affects the joints. Effects include pain, stiffness, inflammation and damage to joint cartilage. Weakened joints can cause instability and visible deformities and can interfere with a person’s ability to perform daily activities, such as bending, walking, brushing teeth and climbing steps.
• Arthritis co-occurs with many other chronic conditions. Activity limitations and painful symptoms due to arthritis may contribute to a person developing other chronic diseases. Approximately half of adults with diabetes, heart disease and high blood pressure also have arthritis.8
• People with arthritis often see their symptoms as a barrier to exercise. Public education messages and special exercise programs can address these concerns.
What Public Health Policies Work to Reduce the Effects of Arthritis?
• Self-management education programs work but are underutilized. By teaching people how to manage arthritis on a day-to-day basis, the Arthritis Self-Management Program has reduced arthritis pain by 20 percent and reduced physician visits by 40 percent. 9 Programs like this are dramatically underused and are still not offered in all areas of the country.
• Exercise programs designed for those with arthritis reduce pain and improve physical function, mental health and quality of life.10 These programs help patients effectively manage their pain from arthritis by learning how to exercise safely. They also can illustrate to patients that arthritis symptoms do not have to be a barrier to exercise, and that physical activity can improve those symptoms.11
• Controlling weight can reduce a person’s risk of developing arthritis and can reduce severity. Losing as little as 11 pounds can reduce the risk of knee osteoarthritis in women by 50 percent.12 Weight loss can also reduce the severity of the symptoms experienced by people with knee osteoarthritis. 13
What Can State Legislators Do?
• Learn about the impact of arthritis in your state. Determine how arthritis affects your state and what actions are being taken by your state health department, Medicaid agency, agencies on aging and other groups.
• Encourage collaboration among state agencies and private partners to address the impact of arthritis. These groups include the state agencies for health and welfare, aging services, disability services, labor and transportation, as well as employers’ health care systems and foundations.
• Educate your peers and constituents about the growing impact of arthritis. Educate other legislators and citizens about the expanding impact of arthritis, its economic burden in your state, and programs that work to reduce its impact.
• Work with local community leaders to foster community and faith-based efforts to address the impact of arthritis. Local programs can increase access to self-management education programs and specialized physical activity opportunities for people with arthritis and other chronic diseases.
• Bring together policy champions for all chronic disease issues to coordinate efforts and meet mutual goals. These include efforts to address obesity, diabetes, heart disease and stroke.
• Support funding and use of chronic disease self-management education programs and specially designed exercise programs. Require state employee health benefits, private insurers and Medicaid to cover these programs and proactively encourage medical referrals to these programs and other related community-based resources.
State Legislative Actions to Address Arthritis:
Florida Senate Bill 1450 (2005): Arthritis Education and Prevention Act.
• SB 1450 creates a statewide program to raise public awareness and increase knowledge of arthritis, the importance of early diagnosis, detection and pain management and effective strategies to prevent arthritis.
• Efforts to coordinate state and local programs and services are supported to reduce the economic and social costs of arthritis.
• The Florida Department of Health is required to establish, promote and maintain an arthritis prevention and education program
http://election.dos.state.fl.us/laws/05laws/ch_2005-221.pdf
Illinois House Bill 2380 (2005): Arthritis Prevention, Control and Cure Act.
• House Bill 2380 directs the Illinois Department of Public Health (IDHP) to establish, promote and maintain an arthritis program to raise public awareness and educate consumers, and to educate and train health professionals, teachers and human service providers.
• IDPH is required to establish a pilot program to study innovative arthritis public health projects and implement community health projects. Under the pilot program, IDPH grants money to academic and health organizations to study arthritis.
http://www.ilga.gov/legislation/fulltext.asp?DocName=09400HB2380lv&Sessi...
State-specific date on arthritis can be found at: http://www.cdc.gov/arthritis/data_statistics/state_data.htm#map
