RA: How High Is the Toll?

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Recently, I met a 60-year-old man with seropositive rheumatoid arthritis (RA) who described himself as “an old country boy.” He was diagnosed with RA 10 years ago. Triple therapy (i.e., methotrexate, sulfasalazine and hydroxychloroquine in combination) and adalimumab failed to help him, but in 2018, he found etanercept. This drug was a game changer for him, improving his symptoms by 90–95%. His insurance “covered” the drug, but the out-of-pocket cost remained enormous. He managed to bring the cost down to $7,500 per year with help from a drug manufacturer co-pay card and paid this for years. But two months ago, he was told he’d reached the maximum use on the co-pay card and it couldn’t be used for the rest of the year. He was forced to stop his medication because he could no longer afford it.

“Which joints are painful and swollen today?” I asked.

“It’d probably be quicker to tell you which ones don’t hurt,” he responded.

Nearly every joint in his body was painful and swollen. He was an industrial mechanic and had just finished a month-long push of machine maintenance at the factory where he worked. To make matters worse, his wife was hospitalized. Between long hours at work, trips to and from the hospital, and the stress of his wife’s illness, things were not going well.

How many of you have heard similar stories? Or perhaps a better question: How many of these stories do you hear in your clinics per day? The simple answer? Too many. The statistically correct answer? Look no further than recent data published by Huang et al. in summer 2024.¹

Background

RA is the most common form of autoimmune arthritis, affecting about 1.36 million adults in the U.S.² The cost of RA medications—in particular, biologics—imparts a significant economic burden to patients and society, contributing to large increases in health expenditures.^3,4 What’s more, RA comes with a hefty humanistic toll on patients’ quality of life, ability to perform activities of daily living and even life expectancy.^5–7

Huang et al. aimed to provide an updated understanding of the economic and humanistic burden of RA among adults in the U.S. Most studies to date have been limited to payers’ perspectives, performed outside the U.S., or focused on patients with difficult-to-treat RA.8-10 Few data exist on the overall health expenditure impact on patients with RA in the U.S. across all payer types. What’s more, few U.S. data exist on the assessment of health-related quality-of-life (HRQoL) in patients with RA. As the largest study evaluating the healthcare expenditure and quality of life of patients with RA compared with all other populations, the study by Huang et al. bridges this gap.