Long-Term Outcomes in Puerto Ricans with Rheumatoid Arthritis (RA) Receiving Early Treatment with Disease-Modifying Anti-Rheumatic Drugs using the American College of Rheumatology Definition of Early RA

Abstract

Background:Early treatment of rheumatoid arthritis (RA) results in better long-term outcomes. However, the optimal therapeutic window has not been clearly established.Objective:To determine the clinical outcome of Puerto Ricans with RA receiving early treatment with conventional and/or biologic disease-modifying anti-rheumatic drugs (DMARDs) based on the American College of Rheumatology (ACR) definition of early RA.Methods:A cross-sectional study was performed in a cohort of Puerto Ricans with RA. Demographic features, clinical manifestations, disease activity, functional status, and pharmacotherapy were determined. Early treatment was defined as the initiation of DMARDs (conventional and/or biologic) in less than 6 months from the onset of symptoms attributable to RA. Patients who received early (< 6months) and late (≥6 months) treatments were compared using bivariate and multivariate analyses.Results:The cohort comprised 387 RA patients. The mean age at study visit was 56.0 years. The mean disease duration was 14.9 years and 337 (87.0%) patients were women. One hundred and twenty one (31.3%) patients received early treatment. In the multivariate analysis adjusted for age and sex, early treatment was associated with better functional status, lower probability of joint deformities, intra-articular injections and joint replacement surgeries, and lower scores in the physician’s assessments of global health, functional impairment and physical damage of patients.Conclusion:Using the ACR definition of early RA, this group of patients treated with DMARDs within 6 months of disease had better long-term outcomes with less physical damage and functional impairment.

Do it fast! Early access to specialized care improved long-term outcomes in rheumatoid arthritis: data from the REAL multicenter observational study

“…Several studies have reported worse outcomes associated with late initiation of RA [10,24,29,30]. Fewer studies, though, have specifically investigated the effects of late assessment by a specialist on RA long-term management outcomes.…”

Treatment Patterns Among Patients with Rheumatoid Arthritis in Puerto Rico

“…Previous studies have provided evidence of disparities in RA treatment in the Puerto Rican population [ 9 , 10 ]. A cross-sectional study of Puerto Ricans with RA looked at disparities between those receiving their healthcare in a managed care system ( n = 67) and non-indigent patients treated in fee-for-service settings ( n = 147) [ 10 ].…”

“…Although arthritis is one of the most prevalent health conditions in Puerto Rico [8], few studies have been conducted in Puerto Rican or Hispanic populations specifically [9][10][11]. Studies in the broader US population have identified some racial and ethnic disparities, reporting higher levels of disease activity and worse functional status in Hispanic patients compared with white patients, although it is not clear why this is the case [12][13][14].…”

“…However, little is known about the patient characteristics or patterns of treatment among people receiving b/tsDMARD treatment for RA in Puerto Rico. The few studies that have been performed have been small [ 9 , 10 ] or have only included particular subsets of patients (e.g. Medicaid and Medicaid–Medicare dual beneficiaries [ 11 ]), and may not be representative of the overall RA population in Puerto Rico.…”

Can we change the natural course of inflammatory bowel disease?

“… 120 – 126 In rheumatology, this concept has now been extensively explored in rheumatoid arthritis since 2010, 127 – 129 with disease-modification outcomes to use clearly defined by the OMERACT consensus, 130 – 132 allowing the achievement of numerous disease-modification trials demonstrating the effectiveness of early therapy to reduce or at least stabilize the risk of undesirable sequelae for up to 20 years. 133 – 138 …”