In a study published in the August 2008 issue of Arthritis & Rheumatism, economists looked at out-of-pocket medical expenditures in Medicare-aged adults with arthritis, and compared them to the out-of-pocket expenses of their peers who had diabetes and heart disease. Out-of-pocket expenses for arthritis averaged yearly growth of 7.3 percent from 1998 to 2004, while annual expenses for diabetes grew by an average of only 5.8 percent over that same time period. Economic analyses show that the biggest chunk of money spent on arthritis goes to ambulatory care – things like clinic visits to see doctors and physical therapists. The next-largest piece of the pie goes to hospital stays for procedures like joint replacements. But the third-greatest cost, and the one that is perhaps hitting patients the hardest, is prescription drug spending.

A study published in the May 2007 issue of Arthritis & Rheumatism found that spending on arthritis medications more than doubled between 1998 and 2004, years when the average income did not increase.

“A lot of the drugs can be extremely expensive,” says Edward H. Yelin, PhD, professor of medicine and health policy at the University of California, San Francisco. For someone who has RA or ankylosing spondylitis, for example, Yelin says the out-of-pocket costs for their biologic drugs can amount to 20 percent of their income.

And the problem is only getting worse as the population ages, and more people need the medications.

In 2007, the number of people taking rheumatologic drugs grew faster than any other drug class, increasing by 7.3 percent over usage in 2006, according to the latest Drug Trend Report, which is published annually by Medco Health Systems, one of the largest pharmacy benefit management companies in the United States. The high treatment rate helped rheumatologic drugs become the fourth-highest cost driver of all prescription medications in 2007, behind only diabetes medications, respiratory drugs, and cancer and transplant therapies.

“It’s a fiscal truth that a lot of people have severe economic hardship because of the costs,” Yelin says.

In 2005, Harvard researchers revealed that unwieldy medical bills contributed to nearly half of all bankruptcies filed in the United States. What was less publicized was a common diagnosis behind the debt: More than a third who were surveyed reported that orthopaedic complaints, a category that includes arthritis, had caused their physical and financial pain.

Similarly, a 2008 Harvard study found that medical bills contribute to half of all home foreclosures.

Hoping to avoid that situation, Jeffrey Herchenroder, a 48- year-old music teacher from Albany, N.Y., has put his house on the market. “I’m basically rationing my health care, and I still can’t swing it,” says Herchenroder, whose medical bills are so high he can no longer afford his mortgage.

Even though Herchenroder’s RA is causing him significantly less pain since he had both hips replaced a year ago, his $70,000 salary will not cover his son’s diabetes and asthma and his wife’s OA. Between them, he says, his family has 15 prescriptions.

“I certainly never expected to find myself in this position,” Herchenroder says. “I saw myself as a pretty responsible person financially. I still think I am.” Surprisingly, in the 2005 Harvard study, 75 percent of people who ended up declaring a medical bankruptcy had health insurance when they initially got sick.