Background:The mortality of patients with rheumatoid arthritis (RA) has been reported to have reduced due to the improved treatment of RA in the last two decades. However, it has not yet been clarified whether the progress of RA treatment improves the prognosis of patients with early RA. We aimed to investigate the mortality rate of patients with early RA over the past two decades.Methods:Patients with RA who participated in the Institute of Rheumatology, Rheumatoid Arthritis (IORRA) cohort within two years of disease onset between 2001– 2012 were enrolled and classified into Group A (2001–2006) and B (2007–2012). The standardized mortality ratio (SMR) versus the Japanese general population and five-year survival rate were calculated. A multiple imputation method was employed for the sensitivity analysis of SMR. The five-year survival rates were evaluated using the Kaplan–Meier method.Results:Groups A and B had 1,609 and 1,608 patients, respectively, of which 167 (10.4%) and 178 (11.0%) patients were lost during follow-up, respectively. Overall, 47 and 45 deaths of patients were confirmed in Groups A and B, respectively. The SMR (95% confidence interval) for Groups A and B were 0.81 (0.59–1.08) and 0.78 (0.57–1.04), respectively, with the condition that all untraceable patients were alive for 5 years. Assuming that the mortality rate of patients lost to follow-up was twice as high as that of the general population, the SMR was 0.90 (0.68–1.19) for Group A and 0.92 (0.68–1.23) for Group B. The 5-year survival rates were 96.9% and 97.0% for groups A and B, respectively (P=0.83).Conclusions:The 5-year mortality of patients with early RA has been comparable to that of the general Japanese population; the 5-year survival rate has been stable over the past two decades.

Objectives To explore patient-reported outcomes (PROs) related to quality of life (QOL) in patients with rheumatoid arthritis (RA) who achieved clinical remission. Methods In the Institute of Rheumatology, Rheumatoid Arthritis (IORRA) dataset, RA patients over 18 years old who met the simplified disease activity index (SDAI) remission criteria in April 2017 were enrolled in this analysis. Pain-visual analogue scale (pain-VAS) (0-100 mm), Patient’s Global Assessment of Disease Activity (0-100 mm), Japanese version of Health Assessment Questionnaire, duration of morning joint stiffness, and fatigue (Checklist Individual Strength 8R [CIS]) were the tools used to evaluate PROs. To assess the contribution of each PRO to the European QOL-5 Dimensions-5 Level (EQ-5D-5L) score, analysis of variance was conducted. Results Among the 2,443 patients with remission, the mean EQ-5D-5L was 0.9. The mean pain VAS and patients’ global assessment of disease activity (Pt-GA) were 7.2 and 7.4, respectively. Factors that significantly contributed to the EQ-5D-5L were pain-VAS (48.8%), CIS score (18.1%), and Pt-GA (15.6%). Around 82.5% of the variance in EQ-5D-5L were explained by the three PROs. Conclusion This study demonstrated that pain-VAS, CIS, and Pt-GA were significant contributors to the EQ-5D-5L score in patients with RA who achieved SDAI remission.

Objectives We performed post-hoc analyses of ORIGAMI study to investigate whether concomitant methotrexate (MTX) influences the clinical outcomes of abatacept in biologic-naïve patients with rheumatoid arthritis. Methods Enrolled patients (n = 325) were divided into two groups according to whether abatacept was prescribed without (MTX−) or with (MTX+) concomitant MTX. We compared the changes in Simplified Disease Activity Index (SDAI), Disease Activity Score-28 with C-reactive protein (DAS28-CRP), and Japanese Health Assessment Questionnaire (J-HAQ) through to 52 weeks of treatment, the abatacept retention rate, and safety. Results At Week 52, the mean SDAI (8.9 vs. 8.8), DAS28-CRP (2.6 vs. 2.6) and J-HAQ (0.92 vs. 0.91) scores were comparable in the MTX− (n = 129) and MTX+ (n = 150) groups. Multivariable logistic regression revealed no significant association between MTX use and SDAI (low disease activity) or J-HAQ (minimum clinically important difference). The abatacept retention rates, estimated using the Kaplan–Meier method, were 73.2% and 66.7% in the MTX− and MTX+ groups, respectively. Adverse events occurred in 47.5% (of 139) and 52.2% (of 159) of patients in the MTX− and MTX+ groups, respectively. Conclusion The effectiveness and safety of abatacept appeared comparable with or without concomitant MTX in this real-world clinical setting.

Objectives To investigate an optimal composite score for disease activity in adult juvenile idiopathic arthritis (JIA) from the viewpoint of the subsequent changes in physical function. Methods Patients with JIA under the following conditions were enrolled: 1) disease onset < 18 years; 2) registered in the Institute of Rheumatology, Rheumatoid Arthritis database by Tokyo Women’s Medical University for the first time between 2000 and 2020; and 3) ≥18 years old at the time of registration. The baseline of each patient was their initial entry into the database. The Simplified Disease Activity Index (SDAI), Disease Activity Score using 28 joints (DAS28), and Juvenile Arthritis Disease Activity Score (JADAS)-27 were compared. Patients were stratified according to mean disease activity scores in each index during the first year from baseline. Trends of estimated mean change in Japanese-HAQ score (ΔJ-HAQ) from baseline to 2 years later was examined across the stratified groups of each index. Results We included 294 eligible individuals (median age at onset, 14.0 years; rheumatoid factor positive in 64.7%). A significant increasing trend of the estimated mean ΔJ-HAQ at 2 years after baseline was observed along with an increase in the mean disease activity during the first year measured using DAS28 (p = 0.01) and SDAI (p = 0.018), but not using JADAS-27. Conclusions Disease activity measured using SDAI and DAS28, but not using JADAS27, was significantly associated with subsequent changes in physical function in transitional and adult patients with JIA.