Twenty‐Year Outcome and Association Between Early Treatment and Mortality and Disability in an Inception Cohort of Patients With Rheumatoid Arthritis: Results From the Norfolk Arthritis Register

Abstract

ObjectiveTo describe the outcome in patients with rheumatoid arthritis (RA) over 20 years from symptom onset, and to assess the association between early treatment (with disease‐modifying antirheumatic drugs/steroids) and mortality and disability during follow‐up.MethodsPatients recruited to the Norfolk Arthritis Register (NOAR) between 1990 and 1994 who met the 2010 American College of Rheumatology/European League Against Rheumatism RA criteria at baseline were included in this analysis. Demographic and clinical variables were collected at baseline and at years 1–3, 5, 7, 10, 15, and 20. Disease activity (swollen joint count [SJC]/tender joint count [TJC]), disability (Health Assessment Questionnaire disability index [HAQ DI]), and mortality over 20 years were determined. Associations between treatment group (early treatment [ET], treatment ≤6 months after symptom onset; late treatment [LT], treatment >6 months after symptom onset; never treatment [NT], no treatment) and mortality and disability were assessed using weighted pooled logistic regression and weighted multilevel mixed‐effects linear regression, respectively. Inverse weights were used to account for confounding by indication and censoring.ResultsThis study included 602 patients with RA (median age 56 years [interquartile range 44–68 years]; 65.9% women). The median SJCs and TJCs were low during the follow‐up period (1–3 swollen joints and 3–6 tender joints). The median HAQ DI score increased after year 1 but remained at low/moderate levels (median 1.25 after year 10). The risk of mortality was reduced in the ET and LT groups compared with that in the NT group. The ET group and the NT group had comparable HAQ DI scores during the follow‐up period (β = 0.03, 95% confidence interval [95% CI] −0.06, 0.12), while the HAQ DI score was increased in the LT group (for LT versus NT, β = 0.10 [95% CI 0.02, 0.17]).ConclusionThe results of this study indicate the importance of early treatment with regard to the long‐term outcomes in patients with RA.

Mortality following new-onset Rheumatoid Arthritis: has modern Rheumatology had an impact?

“…At least historically, RA has been linked to premature death 2. During the last two decades, more intense treatment strategies and new therapeutic options have been introduced in the management of new-onset RA,3 and the average level of RA disease control has improved 4…”

Common language description of the term rheumatic and musculoskeletal diseases (RMDs) for use in communication with the lay public, healthcare providers and other stakeholders endorsed by the European League Against Rheumatism (EULAR) and the American College of Rheumatology (ACR)

“…Early diagnosis, improved treatment options, and applying treatment-to-target principles have improved the percentage of patients in (sustained) remission, and improved the quality of life and work productivity (28,29). Even overall excess mortality in patients with RA in comparison to the general population, which was apparent in previous decades, is lower and even no longer present when RA is diagnosed and treated early and intensively (30,31).…”

“…The average number of rheumatologists in the EU is 1.7 per 100,000 inhabitants, ranging from 0.5 in Ireland to 4.2 in France (16). Similarly, in the USA, the number of rheumatologists ranges from greater than 2 per 100,000 in heavily populated regions to fewer than 1.5 per 1,000,000 in more rural regions (30). However, due to a variety of factors affecting physician workforce, including the increasing prevalence of RMDs, these numbers are changing rapidly.…”

Common Language Description of the Term Rheumatic and Musculoskeletal Diseases (RMDs) for Use in Communication With the Lay Public, Healthcare Providers, and Other Stakeholders Endorsed by the European League Against Rheumatism (EULAR) and the American College of Rheumatology (ACR)

“…Early diagnosis, improved treatment options, and applying treatment‐to‐target principles have improved the percentage of patients in (sustained) remission, and improved the quality of life and work productivity . Even overall excess mortality in patients with RA in comparison to the general population, which was apparent in previous decades, is lower and even no longer present when RA is diagnosed and treated early and intensively .…”