The underestimated long term medical and economic consequences of rheumatoid arthritis.

Rheumatoid arthritis is generally a progressive disease, with radiographic evidence of joint damage, declines in functional status, and premature mortality. In addition, the disease has severe long term economic consequences, including direct costs of medical care, indirect costs of work disability and interference with social roles, as well as the intangible costs of pain, fatigue, helplessness, loss of self-efficacy, and other psychological difficulties. The consequences of rheumatoid arthritis have often been underestimated by health professionals, reimbursement agencies, the general public, and even rheumatologists. Furthermore, the adverse effects of potential therapies have often been regarded as more severe than the 'adverse effects' of untreated disease. More than 50% of patients with rheumatoid arthritis who are younger than 65 years and who were working at onset of disease receive work disability payments, and 0.8% of the US population eligible to work are individuals who have symmetrical polyarthritis but who, unfortunately, are not working. The total earnings gap between individuals with symmetrical arthritis and those in the general population was $US8.9 billion for women and $US8.7 billion for men, for a total of $US17.6 billion (1986 US dollars). The projected costs of knee replacement in patients with rheumatoid arthritis in the US are between $US600 million and $US900 million annually. New approaches to therapy, which include earlier and more aggressive intervention, new drugs, and combinations of drugs, appear required to provide adequate control of inflammation, so that the long term damage of rheumatoid arthritis might be prevented and the considerable costs ameliorated. The possible adverse effects and costs of treatment must be balanced against the adverse effects and underestimated costs of rheumatoid arthritis.