English version - Fit for Work Europe

MSDs and health care professionals
46
5.3.2 Rheumatoid arthritis
The importance of effective and early treatment of RA in reducing joint damage and disability
is now widely acknowledged (Pugner, Scott, Holmes and Hieke, 2000). Since there is currently
no ‘cure’ for RA, the focus of treatment is on controlling signs and symptoms, enabling the
patient to manage their condition and improving the quality of life. Medical treatments for RA are
directed at suppressing one or other part of the joint-damaging processes, the effectiveness of
which has improved in recent years. Since it is well documented that the functional capabilities
of RA patients decline over time, it is critical that patients should be treated as quickly as
possible with disease-modifying anti-rheumatic drugs (DMARDS) to control symptoms and
disease progression. One study found that there is a 73 per cent risk of erosive damage in
patients who wait over a year between symptom onset and referral to rheumatology clinics
(Irvine, 1999 in Luqmani, Hennell, Estrach, Birrell, Bosworth et al., 2006). RA patients in Japan
can be treated either by specialists in internal medicine, of whom 4,000 are currently registered
as rheumatologists with the Japanese College of Rheumatology (JCR), or by orthopaedic
surgeons. There are 5,000 JCR-registered orthopaedic rheumatologists. As the efficacy of
pharmaceuticals improves, internal medicine specialists are playing an increasing role in
the care of RA patients (Miyasaka, 2011), but there is little communication between the two
specialities, often leading to patient confusion.
The current schedule of RA treatment in Japan prioritises the target of clinical remission
(Takeuchi, 2011). 19 However, considering the vast cost of disability and early retirement
associated with this condition, the already enormous strain on the nursing care facilities
in Japan, as well as the evidence for the positive effects of work on health, clinicians must
consider workability as a realistic outcome for people with RA. Growing clinical evidence
demonstrates that biologic drug therapies can have a more powerful effect on RA than
DMARDs, especially in improving job retention and work participation (Halpern, Cifaldi and
Kvien, 2008). In Japan, biological treatment has been approved for administration since 2003
and usage has expanded rapidly since. The access to this new class of biological agents is
restricted to patients with severe and progressive RA who are not responding to traditional
DMARDs. This is mostly due to the high costs of treatment associated with the use of anti-TNF
therapy.
Medical interventions in the form of drug therapy to control inflammation and disease
progression, and surgery to redress structural damage are only part of managing the care of
RA patients. Other important elements include patient education and empowerment, practical
self-management to help deal with symptoms and specialist support to help live with the disease
19 Expert interview
Fit For Work? Musculoskeletal Disorders and the Japanese Labour Market