Rheumatoid Arthritis Progression Rate Has Halved Since 1990

Janis C. Kelly

March 22, 2016

The natural history of rheumatoid arthritis (RA) has changed dramatically since 1990, apparently as a result of advances in RA treatment, such as the use of biologicals and more aggressive "treat to target" clinical approaches. The annual progression rates in studies of long-term progression reported after 1990 were less than half those reported in the prior 25 years, researchers report in an article published online March 8 in Rheumatology.

Adam Young, MD, consultant rheumatologist, University of Hertfordshire, Hatfield, United Kingdom, and colleagues examined annual progression rates reported in long-term studies of RA published between 1965 and 2014. Their systematic review and meta-analysis of long-term cohorts included 28 studies of long-term radiographic progression and 41 studies of predictors of progression.

Baseline radiographic scores were similar in cohorts of patients recruited pre- and post-1990. At baseline, for all trials, the median baseline radiographic score was 2.02% of maximal damage. The baseline score for patients recruited before 1990 was 2.01% and for patients recruited after 1990 it was 2.03%.

Overall, the researchers estimated an annual rate of progression of 1.08% of maximum damage. However, the annual rate for progression of radiographic joint damage scores was 0.68% in the post-1990 cohorts vs 1.50% in the pre-1990 cohorts (P < .05).

According to the authors, differences between the two recruitment periods coincide with changes in clinical management, particularly more intensive use of methotrexate as an anchor disease-modifying antirheumatic drug.

The authors acknowledge not being able to assess the direct effect of treatment. "Nevertheless, it is likely patients received standard contemporary care based on published guidelines about treatment regimens from the time they were being studied," they write.

The main predictive factors identified in the review were acute phase markers, rheumatoid factor positivity, and anti–cyclic citrullinated peptide antibody positivity. The authors write, "Currently, genetic markers do not provide much additional prognostic information that can be applied clinically."

The researchers conclude that the progression of radiographic damage has halved since 1990, probably as a result of improved treatment, and that rheumatoid factor/anti–cyclic citrullinated peptide antibody positivity, along with increased markers of acute phase reactants, are the strongest predictors of radiographic progression, possibly useful for early identification of patients with RA who are at higher risk for progression and who might benefit from early, aggressive treatment.

The study was supported by the UK National Institute for Health Research. The authors have disclosed no relevant financial relationships.

Rheumatology. Published online March 8, 2016. Abstract

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