Session Information
Session Type: Abstract Submissions (ACR)
The Changed Prognosis of Patients with Early Rheumatoid Arthritis
Background/Purpose: The treatment of rheumatoid arthritis (RA) has changed greatly during the past fifteen to twenty years. Major steps in this development were the introduction of methotrexate in the early nineties, the use of combination therapies including high-dose corticosteroids in the late nineties and the introduction of biologic therapies in the past decade. These improvements resulted in a better outcome and clinical remission became an attainable goal for many patients. This study documents trends in patient outcome over the last decades.
Methods: Five-year follow-up data was used from consecutive early RA patients (according to the 2010 ACR/EULAR criteria), included in the periods 1995-1999, 2000-2004 and 2005-2009. Disease activity (DAS-28), functional status (HAQ) and employment status (hours paid work per week) were used as outcome measures.
Results: 322, 369 and 389 patients were included in the three time periods, respectively. Median follow-up was 2 years. Patients included in 1995-1999 were older compared to the patients from the other periods, while the percentage of ACPA positive patients was higher in the last period. General practitioners referred patients increasingly sooner during the last 15 years. In the periods 1995-1999, 2000-2004 and 2005-2009 new patients with RA were treated in the first year with combination therapy in 13, 45 and 59% and/or biologics in 0, 9 and 19%, respectively. The baseline values of DAS-28, but not HAQ and hours paid work, showed a slight decrease over the three periods. However, after 5 years follow-up these differences were no longer significant. The trends in HAQ did not show differences between the three groups. The hours paid work of patients included in 2005-2009 remained stable during follow-up while the other groups showed a decrease over time. Data on radiographic progression are currently being analyzed.
Conclusion: The results document an increasingly better prognosis of early RA patients over the last 15 years. Early recognition and referral by general practitioners has led to a lower disease activity at baseline. Next, more intensive treatment resulted in improved outcomes. However, despite a favorable trend in work participation, there still remains ample opportunity for a further reduction of disease activity and improvement of function.
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Baseline differences between patients of the three time periods
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1995-1999
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2000-2004
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p-value*
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2005-2009
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p– value*
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p– value$
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Age, yr |
57 (15) |
53 (14) |
<0.001
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53 (13) |
<0.001
|
ns |
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Female, % |
69 |
72 |
ns |
72 |
ns |
ns |
|
ACPA, % |
59 |
61 |
ns |
75 |
<0.001
|
<0.001
|
|
RF, % |
57 |
59 |
ns |
58 |
ns |
ns |
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Disease duration, mos. |
5.0 (3.4-8.0) |
4.3 (2.6-7.2) |
0.015
|
2.8 (1.6-5.9) |
<0.001
|
<0.001
|
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GP-delay, wk |
13 (8-29) |
9 (4-21) |
<0.001 |
4 (1-13) |
<0.001 |
<0.001 |
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DAS-28 |
5.2 (1.2) |
5.1 (1.3) |
ns |
4.9 (1.3) |
0.021
|
0.052
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HAQ |
1.13 (0.5-1.75) |
1.13 (0.75-1.75) |
ns |
1.13 (0.63-1.63) |
ns |
ns |
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Work, h/wk |
32.9 (15.9) |
30.0 (11.0) |
ns |
32.6 (12.8) |
ns |
ns |
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Values are expressed as mean (SD) or median (IQR) * p-value compared to period 1995-1999 $ p-value compares period 2000-2004 vs 2005-2009
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Disclosure:
K. Britsemmer,
None;
D. van Schaardenburg,
None.
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