Can I get Life Insurance with Rheumatoid Arthritis?

 

Rheumatoid Arthritis is an inflammatory form of arthritis that causes joint pain and damage, and can definitely affect your life insurance underwriting. Rheumatoid Arthritis attacks the lining of the joints causing swelling. Rheumatoid Arthritis is two to three times more common in women and in men and
generally occurs between the ages of 40 to 60. However Juvenile Rheumatoid Arthritis can also affect young children. Rheumatoid Arthritis is an autoimmune systemic inflammatory disorder. It primarily involves joints on both sides of the body.

RA is a systemic disease that may involve generalized fatigue anorexia and weakness. Extra articular manifestations may occur in virtually any organ including the heart lungs nerves eyes and blood vessels and are usually associated with severe RA. People with RA have an increased prevalence of other serious conditions including cardiovascular disease renal impairment and infections and lymphomas. The cause of RA is unknown.

Rheumatoid factor is an IgG auto antibody is positive in two thirds of the patients with the disease. There is a genetic predisposition with a 4 fold increase in first degree relatives of those affected.

Rheumatoid Arthritis Signs and Symptoms

Signs and symptoms of Rheumatoid Arthritis may include Joint pain Joint swelling joints that are tender to touch, firm bumps of tissue under the skin of the arms (rheumatoid nodules) fatigue signs of extra-articular disease with painful gritty dry or red eyes a vasculitic rash or leg ulcerations.

Rheumatoid arthritis signs and symptoms may vary in severity and may even come and go. Periods of increased disease activity called flares alternate with periods of relative remission.

Rheumatoid Arthritis Screening and Diagnosis

People with Rheumatoid Arthritis tend to have elevated erythrocyte sedimentation rate (ESR or sed rate) which is indicative of the presence of an inflammatory process in the body. Other common blood tests look for antibodies called rheumatoid factor and anti CCP antibodies in the blood. Rheumatoid factor and anti CCP antibodies can be present in people who have chronic infections such as active tuberculosis and other autoimmune rheumatic diseases such as lupus and Jorgen’s syndrome.

The 6 criteria of the American College of Rheumatology are:

• Morning stiffness for at least one hour.
• Arthritis of 3 or more joint areas including the proximal interphalangeal joints wrists elbows knee and ankle.
• Swelling of at least one hand joint.
• Symmetric arthritis rheumatoid nodules.
• Positive rheumatoid factor.
• And characteristic x ray changes including erosions in the hands or wrists.

The diagnosis of RA requires 4 or more criteria be met.

Rheumatoid Arthritis Treatment

There is no cure for rheumatoid arthritis. Treatment for RA aims to reduce the inflammation in the joints. Treatment typically involves medications, Surgery may be necessary in cases of severe joint damage. The types of medication usually include a combination of NSAIDs can relieve pain and reduce inflammation. Advil and Motrin are two examples are examples. Steroids such as prednisone and Medrol reduce inflammation and pain and slow the nerve damage. They do become less effective with long term use.

Doctors are prescribing disease modifying antirheumatic drugs (DMARDs). These are now prescribed early in the course of Rheumatoid Arthritis treatment to slow the course the disease and save the joints and other tissues from permanent damage. Common DMARDS include Plaquenil Azulfidine and Methotrexate. These meds can have potentially serious side effects such as increased susceptibility to infection.

Prognosis of Underwriting Rheumatoid Arthritis

The course of RA is highly variable. After 10 years approximately 20% have no disability or deformity of joints. However most individuals with Rheumatoid Arthritis have a progressive course marked by exacerbations and remissions with some loss of function occurring. Normal activities can often be maintained in about a quarter of these cases.

The most common cause of death in RA is cardiovascular disease cancers or infection. Factors associated with poor prognosis include older age longer duration of the disease, multiple joint involvement high level or rheumatoid factor. Other factors which have the potential to reduce life expectancy include severe disability vasculitis and other extra articular disorders as well as the potentially toxic medications used.

Classes and Severity of Rheumatoid Arthritis

For rating purposes rheumatoid arthritis may be classified as mild moderate or severe.
Criteria for each are:

Mild

Minimal pain or stiffness in peripheral joints no or minimal swelling no deformity. Continuous treatment required. Occasional use of aspirin and negative rheumatoid factor able to carry out normal activities of daily living.

Moderate

Moderate pain and stiffness, more extensive joint involvement slight deformity or limitation of movements in affected joints. Requires frequent or continuous treatment RF is positive ESR < 55. Applicant is able to carry out most or all ADLs with limited difficulty. Or assistance.

Severe

Chronic active disease with no complete freedom from pain, marked deformities with serious restrictions of movement and impairment of function. Lesions (i.e. nodules pulmonary fibrosis) Continuous treatment which includes oral steroids Imuran Embrel Rituxan. Rheumatoid nodules.

Current statistics indicate that 50% of Rheumatoid Arthritis patients are work disabled 10 years after onset. Underwriters will consider whether the occupation requires manual dexterity or physical agility.

In order to properly appraise the risk the term life insurance underwriter will be looking at age of onset the disease duration severity pattern joint affected results of all investigations, any extra articular manifestations. They will also be looking at complications with morbidity as well as level of functioning and occupation history.

Some very mild cases may qualify for preferred consideration but they will be very few. Risk Classification for your term life rates is based on whether the disease process is mild moderate or severe. Mild is generally STD to table 2 and moderate would be Table 2 to 3 with severe generally table 4 to 6. If Rheumatoid Arthritis is associated with any signs of vasculitis or interstitial lung disease these are usually declined. Up to 4 tables may be added for some other extra articular manifestations.

Conclusion

While some very mild forms of Rheumatoid Arthritis might qualify for preferred most will require a rating, based on whether it is mild moderate to severe. Many of the meds used to control the more severe forms or RA can have some toxic side effects. More than 50% of Rheumatoid Arthritis patients are work disabled within 10 years.