Rheumatoid Arthritis is a women’s health issue

If an imaginary women’s health organisation was asked if they would be willing to listen to a presentation on Rheumatoid Arthritis (RA) that is designed to put RA on the radar of women’s health issues, what would the response would be?

I suggest the answer would be a polite ‘thanks but no thanks’. Why would they want to know about this condition? They might think it has nothing in particular to do with women’s health issues and is probably more aligned with older people’s health. Anyway, why would they think it is a disease of any significance?

What do you think the organisation would say if the disease they were asked to consider could develop at any age, commonly between 30 and 50 (often the most economically productive and family intensive years in women’s lives) and that international research has shown:

• this disease occurs 3 times more frequently in women as men. 
• women are more likely to develop RA at an earlier age than men. The incidence of the disease for people under 50, is 4 to 5 times greater for women.
• there may be a hormonal (or some other) factor in the development of RA that means: 
• the disease can disappear during pregnancy, but its appearance can be related to the post-natal period
• breastfeeding may be protective
• many women are diagnosed around the time of pre-menopausal symptoms
• women who have been on the contraceptive pill for many years are not as likely to get RA as women who have not been on the pill
• the side effects of the medication mean that women with RA need to carefully consider their options when it comes to planning a family
• Women with RA seem to have more frequent fertility issues than women who do not have RA

• non-clinical remission is rare, and lifelong medication is almost always required to suppress disease activity 
• people who develop this disease are more at risk of heart disease 
• people who develop the disease have a greater risk of developing some cancers such as Lymphoma 
• people who develop the disease die on average 5 years earlier than the general population 
• some international research has shown that women who develop this disease are: 
• less likely to be diagnosed early 
• less likely to be referred to a rheumatologist than men
• less likely to obtain timely treatment with disease-modifying medication
• more likely to suffer life-changing pain and disability than men 
• we don't know if gender differences in diagnosis and treatment happen in New Zealand.

RA is not a common disease, affecting around one-percent of the population, but if it isn’t treated it carries a high burden for the individual in terms of pain and disablement, and also a high burden for the community and health system because of the high costs of treatment and support as the disease advances. When a person has RA, their immune system, which normally fights infection, mistakenly attacks their joints. It can also affect internal organs and cause a general feeling of exhaustion and unwellness. Disease modifying medication can halt this process and reduce damage to the joints and help prevent irreversible disability.

How does RA affect women’s lives? 

For the women I have spoken with, while severe pain can be constant, it’s the way the disease prevents them from doing things are important to them may be even more frustrating. It means that brushing their hair and showering is a constant fight against pain, lifting their child for a hug is impossible (as is bending down for a kiss). Holding a book open for long enough to read a few pages is a challenge and if performing household chores is measured by the ability to wipe down a bench – then the score is a fail.

For one woman working a high-powered contract-based job, a top performer in her field, it meant putting work on ice (for more than two years and counting, at the time of our discussion) yet still having her child in creche because basic childcare tasks for a pre-schooler were impossible for her to achieve.

For a manual worker it meant accepting redundancy from her secure job, which she took great pride in having the strength for repetitive heavy lifting, and taking up contract hours cleaning restrooms – and having to get her kids to come with her to so they could do the work, which she could not do, before the they went to school.

What can be done?

"Thirty years ago I saw wheelchairs everywhere in the department in which I worked – today, I see none" (Professor Johannes Bijlsma, President-elect, European League Against Rheumatism).

The key to successful treatment is identifying the RA early (ideally within three months of the first symptoms) and obtaining appropriate treatment and healthcare support. But early identification of RA can be difficult because there are many conditions can produce similar symptoms and too often, it is not considered a serious disease. Timely and continuous treatment*, as well as meeting other health and well-being needs that result from RA, is problematic in areas where health services are scarce. 

Advances in treatment are such that, if treated early, with the appropriate disease-modifying medications, people can live a life relatively free of severe pain and disablement for many years. 

Rheumatoid Arthritis has an image problem. I would like to see that women understand the nature and risks of RA, the importance of treatment and are treated fairly if they develop the disease.

recognition - diagnosis - treatment - well-being 

*(‘treating to target’ by measuring disease activity and regularly adjusting therapy to maintain remission)