[Rheumatoid arthritis in the Netherlands. Developments in the knowledge of the epidemiology, etiology and possibilities for prevention.]
Reumatoide artritis in Nederland. Ontwikkelingen in de kennis van de epidemiologie, etiologie en mogelijkheden voor preventie
Bruin KM de
RIVM Report 442003002
This document reviews the latest state of knowledge concerning the etiology, determinants and possibilities for prevention by intervention on life-style factors for rheumatoid arthritis. Both primary, secondary and tertiary prevention are covered. The etiology of rheumatoid arthritis is still unknown, although it becomes more and more clear that rheumatoid arthritis is an auto-immune disease. Most of the determinants play a role in the course of the disease and do not play a role in the etiology. Primary prevention, in which new cases of rheumatoid arthritis do not occur because the causes have been eliminated, is not possible because the etiology of rheumatoid arthritis is still unknwon. Secondary prevention, the detection and treatment of a disease before the 'patient' becomes aware of it, is also not possible bacause there is no known determinant or a combination of determinants that can identify people with rheumatoid arthritis before they are diagnosed as such. Early detection by the general practitioner is important because the treatment can start in an early stage of the disease. Early detection is going to be more important as soon as an immunotherapy is developed that prevents joint destruction. In the future it might be possible to conduct tertiary prevention, limiting the damage of an established disease, by intervention on life-style factors that are determinants for rheumatoid arthritis. Most of the research is done on the effect of diet on the course of rheumatoid arthritis. It seems that fish oil supplements and the consumption of fish improve the health of patients with rheumatoid arthritis. Physical activity is also very important for patients with rheumatoid arthritis because this may prevent functional loss. Not only therapeutic exercise but also recreational exercise should be stimulated. Changes in life style will not cure the patient but the patient might feel better because she/he has less pain or feels less dependent of other people.