Australian Institute of Health and Welfare 2019. Rheumatoid arthritis. Cat. no. PHE 252. Canberra: AIHW. Viewed 20 September 2019, https://www.aihw.gov.au/reports/chronic-musculoskeletal-conditions/rheumatoid-arthritis
Australian Institute of Health and Welfare. (2019). Rheumatoid arthritis. Retrieved from https://www.aihw.gov.au/reports/chronic-musculoskeletal-conditions/rheumatoid-arthritis
Rheumatoid arthritis. Australian Institute of Health and Welfare, 30 August 2019, https://www.aihw.gov.au/reports/chronic-musculoskeletal-conditions/rheumatoid-arthritis
Australian Institute of Health and Welfare. Rheumatoid arthritis [Internet]. Canberra: Australian Institute of Health and Welfare, 2019 [cited 2019 Sep. 20]. Available from: https://www.aihw.gov.au/reports/chronic-musculoskeletal-conditions/rheumatoid-arthritis
Australian Institute of Health and Welfare (AIHW) 2019, Rheumatoid arthritis, viewed 20 September 2019, https://www.aihw.gov.au/reports/chronic-musculoskeletal-conditions/rheumatoid-arthritis
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Rheumatoid arthritis is an autoimmune disease where the body’s immune system attacks its own tissues. Rheumatoid arthritis can affect anyone at any age, and may cause significant pain and disability.
About 458,000 Australians (1.9% of the total population) have rheumatoid arthritis
Rates of rheumatoid arthritis are slightly higher for women (2.3%) than men (1.5%)
In 2016–17, there were 13,213 hospitalisations for rheumatoid arthritis, a rate of 54 per 100,000 population
Rheumatoid arthritis is most common in people aged 75 years or over
At present there is no cure for rheumatoid arthritis. The Australian Models of Care for the management of the disease focus on early diagnosis, early management, and coordination of multidisciplinary care needs [1, 2]. The goal of rheumatoid arthritis treatment is to stop inflammation (put the disease in remission), relieve symptoms, prevent joint and organ damage, reduce complications and improve physical function. Early treatment for rheumatoid arthritis is aggressive in order to stop inflammation as soon as possible .
Medications are primarily used to treat rheumatoid arthritis, however physical therapy and surgery can also be used.
Treatment for rheumatoid arthritis has improved dramatically over the past 20 years, with new medicines now very helpful for people, particularly in the early stages of the disease.
Paracetamol, codeine, and nonsteroidal anti-inflammatory drugs (NSAIDs) are sometimes called the 'first-line' medicines in management of rheumatoid arthritis, as these are the initial medicines provided for symptom relief .
Stronger medications such as corticosteroids, disease-modifying anti-rheumatic drugs (DMARDs) and biologic disease-modifying anti-rheumatic drugs (bDMARDs) may be prescribed when insufficient symptom control is obtained from first-line medicines. Corticosteroids and DMARDs are typically prescribed and monitored by specialist rheumatologists and require close medical monitoring to ensure effectiveness and to minimise side effects. Evidence suggests initiation of aggressive treatment with DMARDs within 12 weeks of symptom onset is associated with less joint destruction and a higher chance of achieving DMARD-free remission as compared with a longer delay in assessment .
bDMARDs are specialised immunosuppressant medications that have been shown to halt or slow the disease process sufficiently to reduce the joint destruction and disability associated with early rheumatoid arthritis . bDMARDs are also used for other autoimmune conditions such as juvenile arthritis, psoriatic arthritis and Crohn's disease.
Treatment options for rheumatoid arthritis, including bDMARDs are available through the Pharmaceutical Benefits Scheme (PBS) and Repatriation Pharmaceutical Benefits Scheme (RPBS) codes .
Maintaining a healthy and active lifestyle is an important management strategy in rheumatoid arthritis. Low-impact physical activity can assist in reducing inflammation, increasing and maintaining mobility and strengthening muscles around affected joints (7). A physiotherapist can prescribe an exercise program to assist in the management of rheumatoid arthritis.
Joint replacement surgery can relieve pain and restore function to joints severely damaged due to rheumatoid arthritis.
Treatment of rheumatoid arthritis often begins with the patient visiting a general practitioner (GPs). This is an important step in the treatment of rheumatoid arthritis because it is optimal for inflammation to be managed early on to reduce the chances of joint damage occurring  and improve long-term outcomes . GPs often conduct initial assessment and diagnosis of rheumatoid arthritis. The time from onset of rheumatoid arthritis symptoms and referral to a specialised rheumatologist for treatment needs to be as efficient as possible to improve long-term treatment outcomes . The RACGP recommends GPs complete diagnosis of rheumatoid arthritis as soon as possible and refer patients to a rheumatologist if joint swelling persists beyond 6 weeks .
Treatment of rheumatoid arthritis is usually managed by general practitioners in partnership with rheumatologists and allied health professionals (such as physiotherapists) and centres on managing pain, reducing inflammation and joint damage, and preventing loss of function.
Severe disease however may require hospitalisation to relieve pain and restore function to damaged joints.
Data from the AIHW National Hospital Morbidity Database (NHMD) show that, in 2016–17:
Source: AIHW National Hospital Morbidity Database (Data table).
From 2006–07 to 2016–17, the age-standardised hospitalisation rate for rheumatoid arthritis increased by 53%: from 32 per 100,000 to 49 per 100,000 population. This increase was driven by a 57% increase in hospitalisations for females (from 46 to 72 per 100,000 females), compared with a 47% increase for males (from 17 to 25 per 100,000 males) (Figure 2).
Note: Rates are age-standardised to the Australian population as at 30 June 2001.
In 2016–17, a total of 21,766 procedures were performed in rheumatoid arthritis hospitalisations. Administration of pharmacotherapy (44%), generalised allied health interventions (including physiotherapy, occupational therapy and dietetics) (23%) and cerebral anaesthesia (5.7%) were the most common groups (blocks) of procedures for rheumatoid arthritis hospitalisations.
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