Principles of rheumatoid arthritis control.

One percent of the UK population suffers from rheumatoid arthritis (RA), with a female to male ratio of 3:1. The disease has a major influence on employment and disability rates. About 15% are classified as having serious illness, which prognostically is equivalent to 3-vessel coronary artery disease. Overall life expectancy for those with RA is reduced on average by 5 years. Financial costs are enormous. Per-patient, each year, direct and indirect costs total about 7000 pounds sterling. Costs escalate with disease severity. In a specialist rheumatology clinic, about 12% of new referrals have RA, and these patients account for more than 40% of the followup workload. The approach to management is changing, with emphasis on earlier, more aggressive intervention. This is acknowledged to improve outcome. For the severe disease, management has been revolutionized by the introduction of biologic agents. RA is managed by a multidisciplinary team, and there are active patient support groups. Advances in knowledge about genetic and immunological mechanisms of disease hold promise for further progress. Never was there a greater need for a successful alliance to deliver effective, high quality services involving government, professionals, patients, and their advocates.