Secular changes in the progression of clinical markers and patient-reported outcomes in early rheumatoid arthritis. (3rd January 2020)

• Record Type: Journal Article
• Authors: Carpenter, Lewis; Nikiphorou, Elena; Kiely, Patrick D W; Walsh, David A; Young, Adam; Norton, Sam
• Is Part Of: Rheumatology. Volume 59:Number 9(2020)
• Page Start: 2381
• Page End: 2391
• Publication Date: 2020-01-03
• Subjects: inflammatory arthritis -- cohort studies -- longitudinal analysis -- patient-reported outcomes; Rheumatism -- Periodicals; Rheumatology -- Periodicals; 616.723005
• DOI: 10.1093/rheumatology/kez635
• Languages: English
• ISSNs: 1462-0324

Abstract

Abstract: Objectives: To examine secular trends in the progression of clinical and patient-reported outcomes in early RA. Methods: A total of 2701 patients recruited to the Early Rheumatoid Arthritis Study or Early Rheumatoid Arthritis Network with year of diagnosis from 1986 to 2011. The 5-year progression rates for patients diagnosed at different points in time were modelled using mixed-effects regression; 1990, 2002 and 2010, were compared. Clinical markers of disease included the 28-joint count DAS and the ESR. Patient-reported markers included the HAQ, visual analogue scale of pain and global health, and the Short-Form 36. Results: Statistically significant improvements in both 28-joint count DAS and ESR were seen over the 5 years in patients diagnosed with RA compared with those diagnosed earlier. By 5 years, 59% of patients with diagnosis in 2010 were estimated to reach low disease activity compared with 48% with diagnosis in 2002 and 32% with diagnosis in 1990. Whilst HAQ demonstrated statistically significant improvements, these improvements were small, with similar proportions of patients achieving HAQ scores of ≤1.0 by 5 years with a diagnosis in 1990 compared with 2010. Levels of the visual analogue scale and the Mental Component Scores of the Short-Form 36 indicated similar, statistically non-significant levels over the 5 years, irrespective of year diagnosed. Conclusion: This study demonstrates improvements in inflammatory markers over time in early RA, in line with improved treatment strategies. These have not translated into similar improvements in patient-reported outcomes relating to either physical or mental health.