If you read yesterday’s blog, “The Mortality Dragon: Do Rheumatoid Arthritis Patients Have to Die Early?” then you know I was glad to find a researcher discussing preventive care for Rheumatoid Arthritis patients, especially in the context of cardiovascular disease. If you read the article “Why do people with rheumatoid arthritis still die prematurely?” you know RA patients get less adequate preventive care than their peers. But do we know why?
First, what preventive care are we talking about?
Here’s what the author said about an earlier study:
“Some years ago our group examined the degree to which patients with RA receive health maintenance and preventive care procedures as recommended by the United States Preventive Services Task Force, a government-appointed independent expert panel whose recommendations are based on systematic review of the evidence of effectiveness of clinical preventive services. Such services include blood pressure testing, lipids profile testing, flu vaccination, pneumococcal vaccination, mammograms and cervical cancer screening. We showed that patients with RA do not receive optimal health maintenance and preventive care services. Davis and colleagues also showed that patients with RA with a clinical diagnosis of heart failure were less likely to undergo echocardiography and less likely to be prescribed cardiovascular drugs—for example, ACE inhibitors, β blockers and diuretics.”
Perhaps you had a look at that 2003 study “Preventive medical services for Rheumatoid Arthritis patients” (linked at the end of yesterday’s post). They mentioned three main categories of illness with associated preventive care:
- Cardiovascular disease is the leading cause of morbidity and mortality with RA. Routine screenings of lipid profiles and blood pressure could make a big difference.
- There is also an increased risk of malignancies with RA. Screenings can allow cancers to be treated early enough to have better outcomes.
- Another leading cause of mortality and morbidity with RA is infection. Routine vaccinations for pneumonia or influenza could make a difference.
Why would RA patients be less likely to receive preventive care?
Writing about this, I feel like I’ve been an undercover investigator getting the inside scoop.
- Many RA patients get what I call “healthcare fatigue.” Our numerous appointments drain so much from our schedules and finances. Of course, patients get tired of going to doctors and being poked with needles.
- RA patients let symptoms go unmentioned that others would not because RA’ers are accustomed to feeling ill. They are also weary of having people think of them as hypochondriacs, so they tend to ignore symptoms.
- RA patients can get so busy fighting RA, we forget that we have the same or greater risks for other diseases as everyone else. When you’ve already had so many medical encounters, it’s hard to remember that you need one more.
- Ironically doctors may not recommend screenings for patients with a chronic disease since patients appear emotionally or physically overcome by the primary diagnosis. One study found that doctors consider the already shortened life expectancy of chronically ill patients when failing to pursue screenings.
- Doctors may assume that RA patients are suffering healthcare fatigue even when they are not. After several years, I insisted on a bone density test. The doc saw the results and said, “I don’t think you want to start another treatment, do you?” This may seem compassionate, but the cold hard fact is, I need to start that bone density treatment whether I want to or not. Another patient would have been scheduled for it.
- Both doctors and patients are guilty of what I call “merely RA syndrome.” Just RA? Please: even if Rheumatoid Arthritis was what caused the bursitis or chest pains or neuropathy or whatever else, it ought to be treated.
- Pain. Some tests are painful for RA patients. I can tell you that unless I get a remission, I don’t want to ever have another mammogram. I was forced to place my shoulders and wrists and elbows into an excruciating position and use my hands to hold on. When I tried to tell the technician about the RA, she scoffed visibly. Other options like ultrasound could be offered; MRI’s could be made easier, etc.
- Confusion: I have never been advised by a rheumatologist to get vaccinations. I’ve even been told “I’m not sure whether you should.” There does not seem to be a universal treatment protocol for vaccinations or for use of antibiotics with DMARDs and a few other things that could be important.
More must be done to increase preventive care with Rheumatoid Arthritis
It was interesting to read that newly diagnosed Rheumatoid Arthritis patients are more likely to receive a blood pressure screening. What changes as RA patients become established with the disease? I believe perhaps a feeling of not only acceptance, but also discouragement sets in making patients less likely to be pro-active about preventive care. Of course these are generalizations and there are more diligent patients who are even seen as guilty of excess “healthcare seeking behavior.” Yes, unfortunately that’s a real word.
Are there more reasons for the “possible bias against screening for the approximately 50 million American women with chronic disorders”? I agree that “the case for conducting further research on cancer screening for women with chronic disease is compelling.” We need to do more about heart disease too. “Preventive care with Rheumatoid Arthritis” will be added to the Tags list today on this website. I will do more to encourage this front in the war on RA.
- The Mortality Dragon: Do Rheumatoid Arthritis Patients Have to Die Early?
- 10 Dumb Questions About an MRI for Rheumatoid Arthritis
- Rheumatoid Arthritis Pain in the Twilight Zone