Clinical Practices And Management Of Rheumatoid Arthritis Prevalence In Women

Rheumatoid arthritis (RA) is a systemic autoimmune disease that manifests itself mainly through joint inflammations and other extra-articular symptoms. (Lawrence et al. 2008). The disease induces painful swellings especially at the joints and can also affect other tissues. (Helmick et al 2008). The objective of this study review is the most appropriate clinical practices and management procedures to help in reducing mortality rates especially amongst women. I am interested in this topic because the prevalence of Rheumatoid arthritis has been observed to be more in women than in other categories, (Anderson et al 2013). It is therefore important for the general population to understand the nature of the disease and the clinical interventions and management procedures that are currently on use to reduce the prevalence of this disease, (Genest et al 2009). The aim of this review is to identify the best clinical interventions and management procedures that are currently on use to curb the prevalence of Rheumatoid arthritis among women.

Best Evidence

Best Practice

Level of Evidence

Study Design

In-text Citation in CDU APA 6^th Format

i. The first evidence was initiating patient self-management initiatives.

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Sue C. et al, (2012).

i. Early diagnosis and treatment of rheumatoid arthritis

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Sara, Carlomaurizio, Serena  & Roberto (2014)

i. Sue C. et al, (2012). Implementing a patient-initiated review system in rheumatoid arthritis: a qualitative evaluation, BMC Health Services Research.

The aim of this study was to evaluate how a patient self-initiated system has been implemented in a wider view. The study was called ‘Direct Access.’ Additionally the study aimed to investigate and analyse the experiences of the staff and patients of the so called ‘direct Access’ system, and how it would help in management of diseases, including rheumatoid arthritis. For conducting the research for the study, twenty three respondents with rheumatic arthritis were followed up with health care professionals. Thematic analysis was employed in analysing notes and interview data. From the result of this study, this evidence of self-initiated practice, would result to increasing patient confidence and empowering them, and help the patient to have an upper hand in taking care of their health. Furthermore, the patient will be able to set his/her goals for going for regular check-ups and this will give the patients a sense of responsibility towards their own condition. It was observed that there was a promotion in self-management for chronic diseases in clinics.

ii. Sara Monti, Carlomaurizio Montecucco, Serena Bugatti and Roberto Caporali (2014). Rheumatoid arthritis treatment: the earlier the better to prevent joint damage 87(7), 659–673.

The aim of this review was to analyse the importance of treating Rheumatoid arthritis early and the effect this would have on the outcome of diseases, with a specific view on the prevalence of the disease among women. In this review, the authors have demonstrated that early diagnosis and treatment of Rheumatoid arthritis, immediate treatment are the basic initiatives towards realizing positive outcomes in the management of Rheumatoid arthritis. The authors assert that the efforts that have been put forward to treatment of this disease realize very little for the management of the disease. According to them, treating diseases with the aim of its remission using carefully chosen protocols is the standard care on management of disease. Integrated manual and automated literature searches were conducted using specific search terms, and from the resulting findings, manual searches were conducted to sanitize the resulting papers and put together relevant information on the chosen research topic. The evidence brought forth by this work is that early diagnosis and early treatment is key to helping improving all radiographic, prognostic, functional and socioeconomic outcomes. This evidence will be very useful in managing Rheumatoid arthritis, especially amongst women.

 iii. Sofia Ajeganova and  Tom Huizinga (2012). Sustained remission in rheumatoid arthritis: latest evidence and clinical consideration. Mayo Clinic Proceedings, 87(7), 659–673.

According to this research, sustained remissions should be the ultimate goal in treatment and management of Rheumatoid arthritis. The aim of this research is to evaluate and analyse the impact of early remissions towards realizing sustained remissions on Rheumatoid Arthritis patients. They assert that sustained remissions are increasing with time, though they may not have been common historically. They argue that sustained remissions can provide anti-rheumatic drugs that are instrumental in modifying the disease. They further say that sustained remission is characterized with positive outcomes in functionality and in favourable reported outcomes from patients. The research methods used in this research paper is desktop research on reviews, journals and government papers. This paper suggests a drug-free guided remission, which would be very instrumental in offering early identifications of patients and treatment of the disease. In the long run, the authors assert that this clinical procedure may reduce the chronicity of this disease. This evidence would be very instrumental to help in the management of this disease.

The evidence, as presented by the authors, is a narrative review that is based on a research that was done on the importance seeking early diagnosis and treatment of Rheumatoid arthritis. Combined automated and manual literature seeking techniques was used in researching for this work, and the resultant papers were searched on to extract relevant information on the topic being researched on. (Sue et al, 2012). The advantage of this technique is that it is very effective since it combines both manual and automated searches, which maximizes the possibility of gathering correct and up to date information on the topic of research. However, one disadvantage with the process of research was that it is based in one source of information, which is PubMed. Ideally, the search should have been based on many sources of information, so as to improve the efficiency of the research. (Smolen et al 2010).

From the results of the research that was done in this work, there are a number of national and international recommendations that the importance of carrying out early diagnosis and treatment, (Dougados et al 2013). According to the authors, from the study that was obtained from clinical trials that were conducted, it was observed that treatment within the first two weeks of the onset of the disease were particularly effective in curbing the activity of the disease, which resulted in improved and better long term and short term outcomes. Further, a specific clinical trial called FinRaCo showed that a delay of up to 4 months is the most appropriate predictor of remission.

This work is a review that was done on recent evidences on patients with rheumatoid arthritis to realize sustained remission and to highlight the significance of sustained remission on the rheumatoid arthritis patients. The results of this review showed that early remission is important to realize a stable remission and therefore key in modifying and reversing the prevalence of the disease amongst the general population, including women.  

The results of this review showed that when patients are given the first responsibility in managing chronic disease, the shift leads to a better management of those conditions because the patient becomes the impetus towards achieving a manageable remission. Furthermore, t self-man agent would lead to a drug – free remission, since people tend to avoid a he disease or be aggressive in treatment process to eliminate it.

§ Person values

The evidences that have been reviewed so far are significant and practical towards achieving the best clinical intervention and procedures for management of Rheumatoid arthritis patients. The first best evidence is key in management of rheumatoid arthritis since there is no one who can best their condition other than the patient. For early treatment diagnosis and treatment of the disease is sensible and really essential, (Vestbo et al 2013). On the same note, early remissions attempt are also very timely and essential in controlling this disease. All these evidences are not costly to implement. The

§ Clinical expertise

From the first evidence, shifting management from clinician first to patients have been proved to be effective in clinics. According to the second best evidence, there were clinical studies which were carried out, and the results was improved long term and short term management of the disease, (D’Haens et al 2008). Additionally, the third best evidence showed that from a clinical point of view, it would be very easy for clinical officers to achieve a total remission from drugs when an early remission has been done.

All the Research that has been done from all the evidences clearly shows that these evidences, if implemented would be effective in management of rheumatoid arthritis, (Mosca et al 2011).

The only barriers to implementation of these evidences would be reluctance on the part of clinical officers and stakeholders, (Papaioannou et al 2010).

References:

Anderson, T. J., Grégoire, J., Hegele, R. A., Couture, P., Mancini, G. J., McPherson, R., … & Genest Jr, J. (2013). 2012 update of the Canadian Cardiovascular Society guidelines for the diagnosis and treatment of dyslipidemia for the prevention of cardiovascular disease in the adult. Canadian Journal of Cardiology, 29(2), 151-167.

Dougados, M., Soubrier, M., Antunez, A., Balint, P., Balsa, A., Buch, M. H., … & Hajjaj-Hassouni, N. (2013). Prevalence of comorbidities in rheumatoid arthritis and evaluation of their monitoring: results of an international, cross-sectional study (COMORA). Annals of the rheumatic diseases, annrheumdis-2013.

D’Haens, G., Baert, F., Van Assche, G., Caenepeel, P., Vergauwe, P., Tuynman, H., … & Vermeire, S. (2008). Early combined immunosuppression or conventional management in patients with newly diagnosed Crohn’s disease: an open randomised trial. The Lancet, 371(9613), 660-667.

Genest, J., McPherson, R., Frohlich, J., Anderson, T., Campbell, N., Carpentier, A., … & Grover, S. (2009). 2009 Canadian Cardiovascular Society/Canadian guidelines for the diagnosis and treatment of dyslipidemia and prevention of cardiovascular disease in the adult–2009 recommendations. Canadian Journal of Cardiology, 25(10), 567-579.

Helmick, C. G., Felson, D. T., Lawrence, R. C., Gabriel, S., Hirsch, R., Kwoh, C. K., … & Pillemer, S. R. (2008). Estimates of the prevalence of arthritis and other rheumatic conditions in the United States: Part I. Arthritis & Rheumatism, 58(1), 15-25.

Lawrence, R. C., Felson, D. T., Helmick, C. G., Arnold, L. M., Choi, H., Deyo, R. A., … & Jordan, J. M. (2008). Estimates of the prevalence of arthritis and other rheumatic conditions in the United States: Part II. Arthritis & Rheumatism, 58(1), 26-35.

Mosca, L., Benjamin, E. J., Berra, K., Bezanson, J. L., Dolor, R. J., Lloyd-Jones, D. M., … & Zhao, D. (2011). Effectiveness-based guidelines for the prevention of cardiovascular disease in women—2011 update: a guideline from the American Heart Association. Journal of the American College of Cardiology, 57(12), 1404-1423.

Papaioannou, A., Morin, S., Cheung, A. M., Atkinson, S., Brown, J. P., Feldman, S., … & Kvern, B. (2010). 2010 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada: summary. Canadian Medical Association Journal, 182(17), 1864-1873.

Smolen, J. S., Aletaha, D., Bijlsma, J. W., Breedveld, F. C., Boumpas, D., Burmester, G., … & Emery, P. (2010). Treating rheumatoid arthritis to target: recommendations of an international task force. Annals of the rheumatic diseases, 69(4), 631-637.

Vestbo, J., Hurd, S. S., Agustí, A. G., Jones, P. W., Vogelmeier, C., Anzueto, A., … & Stockley, R. A. (2013). Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. American journal of respiratory and critical care medicine, 187(4), 347-365.

Sara Monti, Carlomaurizio Montecucco, Serena Bugatti and Roberto Caporali (2014). Rheumatoid arthritis treatment: the earlier the better to prevent joint damage  87(7), 659–673.

Sue C. et al, (2012). Implementing a patient-initiated review system in rheumatoid arthritis: a qualitative evaluation, BMC Health Services Research.

Sofia Ajeganova and Tom Huizinga (2012). Sustained remission in rheumatoid arthritis: latest evidence and clinical consideration. Mayo Clinic Proceedings, 87(7), 659–673.