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High use of healthcare services is characteristic for rheumatoid arthritis (RA). Health spas have provided care for patients with RA in many countries, and many patients with early RA used to be kept in hospitals for several weeks.1 In the 1970s, Swedish researchers reported that over a 13-year follow-up period, patients with RA were admitted to hospital more than twice as often, and spent three times as many days in hospital, as control subjects,2 primarily because of high inflammatory activity. Over the past two decades, however, many rheumatology wards have been closed and rheumatology beds in departments were given away, especially in the Nordic countries.3
Today, rheumatology is characterised by active medication strategies using a combination of early treatment with traditional disease-modifying antirheumatic drugs and other effective drugs, with adjustment during close follow-up. In many countries a multidisciplinary approach to RA means support in a wide array of areas, from devices4 to coping with the disease.5 The patient is taught to take an active role.
Of concern to many are the high medication costs. Early remission has unanimously been defined as a treatment target. In addition to methotrexate and combinations of conventional antirheumatic drugs, a subset of patients with RA needs more powerful though expensive drugs. In the search for remission in a subset of patients with RA, with the prospect of reduced symptoms and reduced or halted future joint damage, use of biological agents with their high costs is unavoidable. These costs are not affordable in all countries.6 The use of biological agents is associated with reduced suffering and improved health. Therefore, these high direct costs may be partly …
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