Background/Purpose: During the past decade there has been an increasing focus on early, aggressive treatment of patients with rheumatoid arthritis (RA), and combined with the availability of biologics this will likely lead to improved patients outcomes. Observational data reflect everyday clinical practice and can provide information about implementation of current treatment recommendations. Our objective was to investigate whether baseline disease activity levels and responses in patients with RA changed during the period 2001-2010.

Methods: Data for this study were provided by the NOR-DMARD register. Adult patients with inflammatory arthropathies starting a new DMARD at five Norwegian rheumatology departments are consecutively included and followed longitudinally. These analyses focused on two groups of RA patients: Methotrexate (MTX) naïve RA patients starting MTX monotherapy (MTX mono), and biologics naïve RA patients starting TNF-inhibitor + MTX (TNFi+MTX). For the descriptive analyses each group was stratified into two-year intervals according to start date. Time trends in several baseline variables were assessed by linear regression analysis with time as the independent variable (continuous 1-10) and the respective baseline variables as dependent variables. CRP, ESR, joint counts and MHAQ were Ln-transformed for the linear regression analyses. EULAR good response and DAS28 remission were similarly assessed by logistic regression analysis.

Results: A total of 2573 patients were included: MTX mono n=1866 [69.9 % female, 62 % RF+, mean (SD) age 56.0 (13.7) years (yrs), time from diagnosis 3.6 (7.7) yrs] and TNFi + MTX n=707 [70.3 % female, 75 % RF+, mean (SD) age 52.1 (13.2) yrs, time from diagnosis 9.1 (9.3) yrs]. Significant time trends were found in both groups for baseline values of DAS28, 28-SJC and CRP (table). Significant time trends were also found for baseline disease duration, SDAI, MHAQ, 28-TJC, ESR, physician global, patient global and joint pain VAS (data not shown). Further, there was a trend towards increasing 6-month DAS28 remission rates over the years in both groups, whereas a gradual increase in the EULAR good response rate was only observed in patients starting MTX mono (table).

Conclusion: Mean baseline disease activity level for patients starting MTX treatment and for patients starting the first TNFi has decreased from high to moderate during the last decade. Mean disease duration also decreased significantly. These findings indicate that clinicians have implemented modern, more aggressive RA treatment strategies which will hopefully result in better long-term patient outcomes.