Background/Purpose: Patients with rheumatoid arthritis (RA) report a reduction in quality of life (QoL) in several aspects when compared to the healthy population. QoL can be evaluated by the 12-Item Short-Form Health Survey (SF-12), a questionnaire that considers the individual’s perception of their health in the last 4 weeks and, through a specific algorithm, measures two scores: Physical Component Summary (PCS) and Mental Component Summary (MCS). The score of both ranges from 0 to 100, and higher scores are associated with better QoL indexes. In the present study, we related clinical, laboratory and therapeutic aspects of a large RA cohort with the PCS indexes of SF-12.

Methods: A prospective multicenter cohort study involving 13 centers specialized in the care of patients with RA. All patients underwent at least 3 clinical evaluations over a 12-month period. Only patients older than 18 years and classified as having RA according to the criteria of 1987 (ACR) or 2010 (ACR/EULAR) were evaluated. SF-12 was used to assess QoL, and only the components relevant to the PCS were considered. The comparison between groups was performed using the Mann-Whitney and Kruskal-Wallis tests.

Results: A total of 1,116 patients (89.43% females, mean age 58 ± 11 years) participated in the study. Patients with erosive disease presented lower PCS score (p = 0.0004) than those without this characteristic. Regarding medications, the use of at least one conventional synthetic DMARD is associated with a higher score (p = 0.0004); the use of at least one biologic or targeted-synthetic DMARD is associated with a lower score (p = 0.0142); and the use of abatacept and tocilizumab is associated with a lower score (p = 0.0276 and p = 0.0116, respectively). In a linear regression model (p < 0.0001), it was found that the patient with the highest score of SF-12 physical component is the one using a synthetic DMARD (p = 0.0016) and not using tocilizumab (p = 0.0374) and abatacept (p = 0.0151). The results are summarized in Table 1.

Conclusion: The best QoL indexes observed in patients using any conventional synthetic DMARD reinforce the importance of this class of medications in the treatment of RA. The results obtained with non-anti-TNF biologic DMARDs may reflect the usual choice of these drugs as third-line therapy.

Table 1 – Measures of position and dispersion of the physical component of 12-Item Short-Form Health Survey and result of the comparison between Kruskal-Wallis (K) and Mann-Whitney (M) groups.

K: Kruskal-Wallis test; M: Mann-Whitney test; conventional synthetic DMARD: at least one between methotrexate, leflunomide, hydroxychloroquine and sulfasalazine; biologic DMARD: at least one between adalimumab, infliximab, etanercept, certolizumab, golimumab, tocilizumab, abatacept, rituximab and tofacitinib.