Background/Purpose: Patient-reported outcomes are recognized as important for evaluating the disease status of rheumatoid arthritis (RA). The EuroQol 5-dimensional descriptive system (EQ-5D) has been used to assess health-related quality of life (HR-QOL) in clinical research and pharmacoeconomical studies. RA is a chronic disease associated with pain, fatigue, disability, and functional loss, which can markedly decrease a patients’ quality of life (QOL). Treatment strategies for RA have changed greatly since the introduction of biological DMARDs (bDMARDs). The QOL of RA patients can be evaluated using EQ-5D in daily practice.

We analyzed a clinical database of a large prospective observational cohort of patients with RA. Subclasses with distinct patterns were identified in the Japanese version of EQ-5D in RA patients who received biologics. The  clinical features of patients whose QOL improved after use of biologics in daily practice was then examined.

Methods: Since October 2000, we have established a large observational cohort of RA patients in our institute, the Institute Of Rheumatology, Rheumatoid Arthritis (IORRA). Essentially, all RA patients who attend our clinic are asked every 6 months to answer questionnaires including the EQ-5D, disease activity score 28 (DAS28), and Japanese version of the health assessment questionnaire (J-HAQ). More than 5,000 RA patients are included in the cohort, with 813 patients who received bDMARDs being enrolled in this study. The EQ-5D scores of these 813 patients were recorded biannually for 2.5 years and the latent classes of time trends in EQ-5D score based on posterior probability examined after initiation of bDMARDs. The clinical characteristics of each latent class were then compared.

Results: The 813 patients were classified into 4 classes based on time-related changes in EQ-5D score: Class 1, patients with persistent high score of around 0.9 (n=301); Class 2, patients whose score improved from about 0.7 to 0.9 after use of bDMARDs (n=73); Class 3, patients with a persistent moderate score of around 0.7 (n=348); and Class 4, patients with a persistent low score of under 0.6 in spite of use of bDMARDs (n=166). The patients in Class 2 were younger and had a shorter disease duration (p<0.05), higher DAS28 (p<0.001), lower J-HAQ (p<0.05) and more frequent use of non-steroidal agents (p<0.05) than the patients in Class 3. 

Conclusion: This study suggests that QOL is less likely to improve in patients with RA whose disability and deterioration of QOL has already become established despite the use of bDMARDs. We also determined the clinical features of RA patients whose QOL improved after daily use of biologics.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/trajectories-of-eq-5d-in-ra-patients-treated-with-biologics-using-the-iorra-cohort/