Rheumatoid arthritis (RA) is an inflammatory arthritis of unknown aetiology. It typically affects many joints, causing acute inflammation, in most cases leading to joint erosions and long-term damage. RA is the most common form of inflammatory arthritis and is estimated to affect about 1% of the population. About 70% of RA patients are women, the majority of them getting their first symptoms of RA between the ages of 30 to 50 years.
Socially, the most immediate impact of RA would be its effect on working life. Painful swollen hands usually make most jobs very difficult to do, leading to loss of productivity in general and loss of income to the individual concerned. Unchecked RA disease activity leads to irreversible joint damage which not only makes returning to work impossible but also causes disability, increasing the burden of care of these relatively young patients to their families, community and the welfare system.
Recent research also shows that RA is also associated with increased mortality, with RA patients at higher risk of premature death from ischaemic heart disease (IHD) and cerebrovascular disease (CVD). Effective treatment of RA as well as dealing with the more traditional risk factors for IHD and CVD such as hypertension, diabetes and hyperlipidaemia can reduce this increased mortality in patients.
It is current rheumatological practice to treat RA patients aggressively with disease modifying drugs (DMARDs) as this has been shown to improve disease activity and to slow the progression of joint damage. This in turn would improve the quality of life of RA patients, reduce their potential for disability and enable those at work to continue to work productively. The recent introduction of powerful albeit expensive biologic agents further expands the rheumatologist's ability to suppress RA disease activity to such a degree that severely affected patients can be induced into remission.
Several factors hamper the treatment of RA patients in Malaysia. The first has to be a lack of awareness of RA and its consequences not only among the general public but also, in some cases, within the medical community. There is also a severe shortage of rheumatologists in the country. It is estimated that, to provide an effective service, there should be one rheumatologist for every 100,000 population. For Malaysia this would translate to about 200 rheumatologists required. We currently only have 25.