Secular changes in the progression of clinical markers and patient-reported outcomes in early rheumatoid arthritis

Lewis Carpenter,Sam Norton,David A Walsh,Patrick D W Kiely,Elena Nikiphorou,Adam Young

doi:10.1093/rheumatology/kez635

Abstract

ObjectivesTo examine secular trends in the progression of clinical and patient-reported outcomes in early RA.MethodsA 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.ResultsStatistically 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.ConclusionThis 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.

Highlights

The last 30 years have seen many changes in the presentation of RA in the clinics, as well as how it isThere is growing evidence that these therapeutic changes have had positive effects on lowering inflammation and halting the progression of structural joint CLINICAL SCIENCEVC The Author(s) 2020
Mean baseline DAS28, visual analogue scale (VAS) and HAQ levels were similar across the two cohorts, whilst patients in Early Rheumatoid Arthritis Network (ERAN) had lower mean levels of ESR and HAQ, along with a smaller proportion of patients with seropositive RA
These findings were corroborated in a recent metaanalysis using data from 29 early RA cohorts of over 10 000 patients, which found that levels of pain, fatigue, physical function and general measures of mental health had not improved when comparing pre- and post-2002 cohorts of patients with early RA

Summary

Introduction

The last 30 years have seen many changes in the presentation of RA in the clinics, as well as how it isThere is growing evidence that these therapeutic changes have had positive effects on lowering inflammation and halting the progression of structural joint CLINICAL SCIENCEVC The Author(s) 2020. The last 30 years have seen many changes in the presentation of RA in the clinics, as well as how it is. There is growing evidence that these therapeutic changes have had positive effects on lowering inflammation and halting the progression of structural joint CLINICAL SCIENCE. There was little difference in functional disability, and it is unclear whether these improvements in disease activity have translated into improvements in key PROs, such as mental health, fatigue and pain [9,10,11,12]

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