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Monday, June 2, 2014
  Clinical Accuracy Spoken Here  

RA: Extra-articular Manifestations

In addition to affecting many of the body's diarthrodial joints, RA exhibits extra-articular manifestations. The number of extra-articular manifestations increases in relationship to the duration of the disease.

Extra-articular involvement is more frequent in:

  • Men than women
  • Seropositive patients

The pathogenic common denominator for RA extra-articular manifestations is systemic autoimmunity. Predictors of extra-articular manifestations are:

  • Severe joint disease
  • Positive anti-nuclear antibody titer
  • IgA rheumatoid factor (RF)
  • HLA-DR haplotypes

[Reference: RA, Module B, Assessment and Complications]
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  Excellence in Case Mgmt  

RA: Initially, Assess for Barriers

The RA patient population may be one of the more challenging to merit initial screening for CM when prompts are made solely on diagnostic coding.

As patients are identified for Case Management, their needs are many. RA is a complicated chronic disease with a long trajectory. CMs must be sensitive to realizing that there may be existing barriers to establishing open communication already in place at the time of diagnosis. The barriers patients may encounter along the path to being diagnosed may leave lingering resentment which could impinge on the patient's willingness to comply with needed changes.

[Reference: RA, Module D, CM Role]
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  Improving Patient Care...  

RA: CMs Can Make a Difference

RA co-morbidities present clinicians and patients with difficulties in managing RA.

Pain is common and must be controlled. The American Pain Society Guideline for the Management of Osteoarthritis, Rheumatoid Arthritis and Juvenile Chronic Arthritis, has a treatment flowchart which provides RA-appropriate pain-related interventions. Both Pharma and non-pharma therapies have proven useful in managing RA pain.

Studies demonstrate co-management between primary care physicians and arthritis specialists can improve the quality of preventive care for RA patients. By coordinating the provision of health maintenance and preventive care CMs can make a difference in the treatment of RA patients.

[Reference: RA, Module D, CM Role]
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Tom RasmussenTom Rasmussen
Publisher
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