• Crohn's disease is an inflammatory bowel disease (IBD), the general name for diseases that cause inflammation in the intestines. Crohn's disease may also be called ileitis or regional enteritis.
  
  
• Crohn's disease may cause inflammation in any part of the digestive tract. Most commonly, Crohn's disease involves the small and large intestines.
  
  
• The most common symptoms of Crohn's disease are abdominal pain (often in the lower right area) and diarrhea. Crohn's sufferers may also experience rectal bleeding, weight loss (typically up to 10% of body weight may be lost), fatigue, and fever. Bleeding may be serious and persistent, leading to anemia (lower than normal amount of circulating red blood cells or hemoglobin).
  
  
• Patients with Crohn's disease may experience complications such as narrowing of the intestine, obstruction, abscesses, and fistulas (abnormal channels connecting two loops of intestine, or between the intestinal wall and other organs, including the skin).
  
  
• Although Crohn's disease primarily involves the bowel, it may manifest in other organs as well, including the eyes, mouth, skin, liver, kidney, and joints.
  
  
• The clinical course of Crohn's disease is characterized by periods of symptom exacerbation interspersed with clinical remission.
  
  
• The inflammation in Crohn's disease is transmural, patchy, and occasionally granulomatous and can involve any portion of the intestinal tract from the mouth to the anus.
  
  
• The diagnosis of Crohn's disease is determined by characteristic clinical, radiographical, endoscopic, and histological findings. Approximately 80% of patients with Crohn's disease will require surgery, although the disease typically recurs after surgical resection.¹
  
  
• Fistulas occur in approximately 30% of patients with Crohn's disease.²
  
  
• Patients with Crohn's disease are at increased risk of cancer of both the small and large intestine.
  
  
• Crohn's disease seems to run in some families. About 25%-30% of people with Crohn's disease have parents or siblings with some form of IBD.³
  
  
• It is estimated that Crohn's disease affects approximately 400,000 people in the United States⁴ with mean annual medical costs exceeding $1.2 billion (in 1990). Hospitalizations and surgeries represent 80% of these costs.⁵
  
  
• The cost of lost work days for IBD patients has been estimated at almost a half-billion dollars a year.⁶
  
  
• Crohn's disease can affect persons of any age, but in most studies, the incidence of Crohn's disease reaches its peak between ages 15 and 30 years.⁷ A second smaller peak in incidence has been observed later in life.⁸

Rheumatoid Arthritis

• Rheumatoid arthritis is a chronic autoimmune inflammatory disorder of unknown etiology that occurs in approximately 2.1 million people and is more prevalent among women than men.⁹
  
  
• Rheumatoid arthritis is a chronic, progressive and disabling disease. Despite intensive research, the cause of RA remains unknown.
  
  
• More than half of RA patients are younger than age 65.¹⁰
  
  
• The clinical course of rheumatoid arthritis can vary considerably. The main presenting symptoms of rheumatoid arthritis are: pain, marked morning stiffness, swelling and tenderness of the joints, typically symmetrical, impaired physical function. Constitutional symptoms of rheumatoid arthritis include: fever, weight loss, fatigue/malaise.
  
  
• Manifestations/complications of rheumatoid arthritis include: joint deformities resulting from cartilage destruction and bone erosion, rheumatoid nodules, rheumatoid vasculitis, pleuropulmonary manifestations, including pulmonary fibrosis, serositis, eye inflammation, osteoporosis, requirement for surgery to normalize functional capacity and/or range of motion.
  
  
• The pathogenesis of RA is likely multifactorial, involving autoimmunity and genetic factors; infectious agents are also suspected of having a role.
  
  
• Up to two thirds of RA patients have a reduced work capacity.¹¹
  
  
• RA is associated with a major decrease in survival.¹²
  
  
• Economic Impact of Rheumatoid Arthritis
  
  
  • Medical costs for RA patients are 3 times those of age- and sex-matched non-RA patients.¹³
    
    
  • Rheumatoid arthritis patients make more than 3.5 million physician visits¹⁴ and account for over 225,000 hospitalizations annually.¹⁵
    
    
  • RA patients have 45% higher hospital admission rates than non-RA patients.¹⁶

References: 1. Saibil F. Crohn's disease and ulcerative colitis: Everything you need to know. Buffalo, NY: Firefly Books; 1997: 127. 2. Peiken, S. Gastro-intestinal Health; HarperCollins Publishers; 1991: 112. 3. Saibil F, 10-11. 4. Patient Sizing Study, July 1998, Centocor Market Research. 5. Hay JW, Hay AR. Inflammatory Bowel Disease: Cost of Illness. Journal of Clinical Gastroenterology. 1992; 14:309-317. 6. Hay JW, Hay AR, 314. 7. Saibil F. Crohn's disease and ulcerative colitis: Everything you need to know. Buffalo, NY: Firefly Books; 1997: 9. 8. Regueiro MD, Peppercorn MA. Inflammatory bowel disease in the elderly. Resident Staff and Physician. 1995; 41 (12):41-46. 9. Lawrence RC, Helmick CG, Arnett FC, et al. Estimates of the prevalence of arthritis and elected musculoskeletal disorders in the United States. Arthritis Rheum. 1998;41:778-799. 10. IMS America NDTI, 1998. 11. Allaire SH, Prashker MJ, Meenan RF. The costs of rheumatoid arthritis. PharmacoEconomics. 1994;6(6):513-522. 12. Mitchell DM, Spitz PW, Young DY, Bloch DA, McShane DJ, Fries JF. Survival, prognosis, and causes of death in rheumatoid arthritis. Arthritis Rheum. 1986;29(6):706-714. 13. Callahan LF. The burden of rheumatoid arthritis:facts and figures. J Rheumatol. 1998;25 (suppl 53):8-12. 14. IMS America NDTI, 1999. 15. HCIA-Sachs Outpatient View, 1999. 16. Yelin E. The costs of rheumatoid arthritis: absolute, incremental, and marginal estimates. J Rheumatol. 1996;23 (suppl 44):47-51.