Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2018 Oct 30:2:32.
doi: 10.1186/s41927-018-0039-2. eCollection 2018.

The extra-articular impacts of rheumatoid arthritis: moving towards holistic care

I C Scott  1   2 , A Machin  1 , C D Mallen  1 , S L Hider  1   2
Affiliations
Review

The extra-articular impacts of rheumatoid arthritis: moving towards holistic care

I C Scott et al. BMC Rheumatol. .

Abstract

Although treat-to-target has revolutionised the outcomes of patients with rheumatoid arthritis (RA) there is emerging evidence that attaining the target of remission is insufficient to normalise patients' quality of life, and ameliorate the extra-articular impacts of RA. RA has a broad range of effects on patient's lives, with four key "extra-articular" impacts being pain, depression and anxiety, fatigue and rheumatoid cachexia. All of these are seen frequently; for example, studies have reported that 1 in 4 patients with RA have high-levels of fatigue. Commonly used drug treatments (including simple analgesics, non-steroidal anti-inflammatory drugs and anti-depressants) have, at most, only modest benefits and often cause adverse events. Psychological strategies and dynamic and aerobic exercise all reduce issues like pain and fatigue, although their effects are also only modest. The aetiologies of these extra-articular impacts are multifactorial, but share overlapping components. Consequently, patients are likely to benefit from management strategies that extend beyond the assessment and treatment of synovitis, and incorporate more broad-based, or "holistic", assessments of the extra-articular impacts of RA and their management, including non-pharmacological approaches. Innovative digital technologies (including tablet and smartphone "apps" that directly interface with hospital systems) are increasingly available that can directly capture patient-reported outcomes during and between clinic visits, and include them within electronic patient records. These are likely to play an important future role in delivering such approaches.

Keywords: Cachexia; Fatigue; Mental health; Pain; Rheumatoid arthritis.

PubMed Disclaimer

Conflict of interest statement

Not applicable.Not applicable.The authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Spydergrams Showing Impact of Attaining Remission on Short-Form 36 Health Profiles in Patients with Established RA. Panel A = SF-36 health profiles in German RA patients, stratified by disease activity status (captured using the simplified disease activity index) and compared to the healthy German population. Panel B = SF-36 health profiles in 205 English RA patients enrolled to the TACIT trial at the end-point of 12-months, stratified by disease activity status (captured using the DAS28). PF = physical functioning, RP = role physical, BP = bodily pain; GH = general health; VT = vitality; SF = social functioning, RE = role emotional; MH = mental health. Figures adapted with permission under the creative commons attribution license from the original published papers [5, 7]
Fig. 2
Fig. 2
Stepped Care Approach to Managing Depression and Anxiety in Adults (based on NICE guidelines). CBT = cognitive behavioural therapy; GAD = generalised anxiety disorder. Figure produced using information provided in NICE guidelines for managing depression in adults [54] and adults with a chronic physical health problem [75], alongside guidelines for managing generalised anxiety disorder in adults [53]
Fig. 3
Fig. 3
Conceptual Model for RA-Related Fatigue Proposed by Hewlett et al [87]. Figure produced using concepts reported by Hewlett et al [87]
See this image and copyright information in PMC

References

    1. Smolen JS, Breedveld FC, Burmester GR, Bykerk V, Dougados M, Emery P, et al. Treating rheumatoid arthritis to target: 2014 update of the recommendations of an international task force. Ann Rheum Dis. 2016;75(1):3–15. doi: 10.1136/annrheumdis-2015-207524. - DOI - PMC - PubMed
    1. Drossaers-Bakker KW, de Buck M, van Zeben D, Zwinderman AH, Breedveld FC, Hazes JM. Long-term course and outcome of functional capacity in rheumatoid arthritis: the effect of disease activity and radiologic damage over time. Arthritis Rheum. 1999;42(9):1854–1860. doi: 10.1002/1529-0131(199909)42:9<1854::AID-ANR9>3.0.CO;2-F. - DOI - PubMed
    1. Welsing PM, van Gestel AM, Swinkels HL, Kiemeney LA, van Riel PL. The relationship between disease activity, joint destruction, and functional capacity over the course of rheumatoid arthritis. Arthritis Rheum. 2001;44(9):2009–2017. doi: 10.1002/1529-0131(200109)44:9<2009::AID-ART349>3.0.CO;2-L. - DOI - PubMed
    1. Klarenbeek NB, Koevoets R, van der Heijde DMFM, Gerards AH, Ten Wolde S, Kerstens PJSM, et al. Association with joint damage and physical functioning of nine composite indices and the 2011 ACR/EULAR remission criteria in rheumatoid arthritis. Ann Rheum Dis. 2011;70(10):1815–1821. doi: 10.1136/ard.2010.149260. - DOI - PubMed
    1. Radner H, Smolen JS, Aletaha D. Remission in rheumatoid arthritis: benefit over low disease activity in patient-reported outcomes and costs. Arthritis Res Ther. 2014;16(1):R56. doi: 10.1186/ar4491. - DOI - PMC - PubMed

LinkOut - more resources