Early Treatment Boosts Long-term Rheumatoid Arthritis Outcomes

Bridget M. Kuehn

April 24, 2017

Improved treatment, including early treatment, for rheumatoid arthritis appears to have long-lasting benefits for patients and may be contributing to reduced arthritis-related mortality in many countries, according to a pair of studies published in Arthritis & Rheumatology.

Rheumatoid arthritis has been linked to increased disability, reduced quality of life, and increased mortality. But advances in treatment for the disease, including a shift toward early treatment and use of newer medications, during the last 2 decades have led to improved patient outcomes in the near term. However, less is known about the long-term effect of the updated treatment approaches on quality of life and arthritis-related deaths.

To better understand the long-term effects of treatment, James Gwinnutt, BS, from the University of Manchester in the United Kingdom, and colleagues analyzed data from the Norfolk Arthritis Register, which recruited patients between 1990 and 1994 and followed up with them periodically over the course of 20 years. They stratified the 602 patients into three groups: those who received early treatment, those who received late treatment, and those who did not receive treatment because their symptoms were not severe enough to warrant it.

On average, disease severity, as determined by swollen and tender joints, remained low for all groups during the follow-up period. Disability rates initially fell for participants; however, after year 7, they increased above baseline and continued to increase for the duration of follow-up.

The patients who received early treatment had disability rates comparable to those whose symptoms were mild enough to forgo treatment (β, 0.03; 95% confidence interval [CI], −0.06 to 0.12), whereas patients who received late treatment experienced increased disability compared with the no treatment group (β, 0.10; 95% CI, 0.02 - 0.17).

During the study, 265 (44%) patients died. There was no significant difference in mortality in either treatment group compared with the no treatment group.

"This research emphasizes the importance of early treatment and the long-term benefits of early treatment," said senior author Suzanne Verstappen, PhD, from the Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, School of Biological Sciences, Manchester Academic Health Science Centre, University of Manchester, United Kingdom, in a press release.

"In the early 1990s, when this study started, only 30 percent of patients received early treatment, but this number has increased significantly in the last decade," Dr Verstappen continued. "It's expected that in the next 10 years, newly diagnosed patients will have a better future with respect to functional ability, less severe disease activity, and improved quality of life."

Mortality Down in Global Study

A second study published at the same time found reduced rates of rheumatoid arthritis–related mortality globally between 1987 and 2011. In the study, Aliasghar Kiadaliri, PhD, from Lund University in Sweden, and colleagues analyzed data on 31 countries in Europe, North America, and Australasia from the World Health Organization mortality database.

The authors found that arthritis-attributed deaths fell from 9281, or 0.12% of all deaths, in 1987 to 8428, or 0.09% of all deaths, in 2011. The average decline in arthritis-related mortality was 3% per year.

Twenty-one of the countries saw reductions in arthritis-related mortality of 25% or more during the study period, whereas three countries experienced increases, suggesting substantial variation remains between countries.

Dr Kiadaliri and colleagues attributed the mortality declines to several factors, including improved treatments and milder forms of rheumatoid arthritis.

Although the mortality findings are welcome, they may also have important policy implications for countries with growing numbers of elders living with arthritis.

"Although increased survival with rheumatoid arthritis is great news, it might lead to a greater share of our aging population having the disease and in need of health services," said Dr Kiadaliri in a press release.

"This needs to be accounted for in health care planning."

The authors have disclosed no relevant financial relationships.

Arthritis Rheumatol. Published online April 20, 2017. Gwinnutt abstract, Kiadaliri abstract

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