Patient-Centred Care and Disease Understanding
Patient Information and Decision-Making Lifestyle Interventions Comorbidities and Extra-Articular Disease Patient Information and Decision-Making The aim of treatment is to maintain a good quality of life and physical function. A management plan should be developed based on shared decision-making between patients and clinicians, predicated on patients’ values, goals, preferences and comorbidities
Patient Information and Decision-Making
Comorbidities and Extra-Articular Disease
Patient Information and Decision-Making
The aim of treatment is to maintain a good quality of life and physical function. A management plan should be developed based on shared decision-making between patients and clinicians, predicated on patients’ values, goals, preferences and comorbidities. Patient education should include information about RA disease and complications, assessment of disease, treatment goals, medications and adherence.[24]
Self-management interventions, including medication management, physical activity, disease-related problem solving, emotional wellbeing, communication skills, and use of community resources including patient support groups, should be emphasised.[25] Lifestyle improvements complement medical treatment but do not replace it.
There is strong evidence that being cared for primarily by a rheumatologist improves outcomes for persons with RA.[26,27] All RA patients should ideally be seen by a rheumatologist, particularly those with diagnostic uncertainty, moderate or high disease activity, functional impairment, intolerance to DMARDs, and extra-articular disease.
Care of the RA patient requires a multidisciplinary holistic approach that may include an occupational therapist, podiatrist, physiotherapist, orthopaedic surgeon, psychologist and social worker. A rheumatology nurse can offer patient education and support, with positive effects on adherence to therapy and HRQoL.[28]
Lifestyle Interventions
Adoption of a healthy lifestyle is of benefit to all RA patients.
Smoking cessation should be encouraged, as cigarette smoking has been shown not only to increase the risk of developing RA, but also to worsen the severity of joint disease, extra-articular complications and comorbidities of RA.[29]
Exercise (particularly supervised rehabilitation programmes) strengthens muscle, increases grip strength and functional capacity, and improves cardiovascular fitness, without worsening RA disease activity.[30] All RA patients should be encouraged to participate in regular aerobic and resistance exercise training.
Obesity is prevalent in early and established RA and is associated with poorer disease outcomes and with comorbidities.[31] Losing weight may improve RA disease activity.[32]
Comorbidities and Extra-Articular Disease
The majority of RA patients have one or more comorbidity leading to premature mortality, poorer RA disease control, functional impairment and reduced HRQoL.[33,34]
Accelerated atherosclerosis leading to cardiovascular events, infections, non-steroidal anti-inflammatory drug (NSAID)-induced gastritis and osteoporosis are the major comorbidities in RA and need regular screening and evidence-based management.[34,35]
Extra-articular disease, particularly interstitial lung disease, and uncontrolled pain, fatigue, depression and anxiety need to be actively screened for and holistically managed.[36]
Screening for hepatitis B, hepatitis C, HIV and TB should be done at presentation. The vaccination status, pregnancy plans, and contraception and lactational status of the patient should be reviewed and discussed regularly.
Tarr, G., Govind, N., Seboka, M., Gardiner, E., & Hodkinson, B. (2024). South African Rheumatism and Arthritis Association 2024 updated guidelines for the management of rheumatoid arthritis. South African Medical Journal, 114(9), e2598.