Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.


TNF Therapy Reduces the Odds of Worsening Disability Trajectories in Rheumatoid Arthritis over at Least 2 YearsData from the NDB-Portugal Cohort.

Pedro1,  Sofia, Benito-Garcia1,  Elizabeth, Vasconcelos1,  Joana, Chaves1,  Irina, Marques1,  Rita, Rodrigues1,  Andreia, Michaud3,  Kaleb

Bioepi Clinical and Translational Research Center, Oeiras, Portugal
National Databank for Rheumatic Diseases, Kansas
University of Nebraska Medical Center, NE

Background:

The trajectories of the health assessment questionnaire (HAQ) disability scores among rheumatoid arthritis (RA) patients are known to have different courses. Wolfe et al. (2000) characterized them as being non linear, chaotic and non-time determined. It is suggested that HAQ be measured between clinic visits to monitor disability and the effect of therapy. Many studies have defined the predictors of HAQ, but few have evaluated the predictors of HAQ trends among RA patients.

Objective:

To investigate the predictors of worsening disability trends compared to improving, no change or other patterns of disability trajectories among RA patients over at least 2 years.

Methods:

646 RA patients from the ongoing biannual NDB-Portugal cohort (started in 2003) with at least four consecutive HAQ scores per patient during their follow-up were used in this analysis. Questionnaires included socio-demographics, disease characteristics, function, etc.

The proportion defined by the number of 6-month positive increments in HAQ scores (worsening function) divided by the total number of differences was computed per patient and used to define patients' trajectories. The outcome was then defined as the presence of a trend of worsening disability (when the proportion was > 0.5). Univariate (UV) and multivariate (MV) generalized estimating equations (GEE) were used to study the predictors of a worsening disability trend. Age, educational level, disease duration, paid form of work, retirement, number of total major comorbidities, SF-36 mental component (MCS) (0–100, 0 is worse), RADAI (0–10, 10 is worse), the VAS scales of sleep, fatigue and pain (VAS 0–10, 10 is worse), the use of current TNF (with or without concomitant DMARDs) vs. traditional DMARD therapy and corticosteroids, were used as possible predictors.

Results:

168 patients of 646 (26%) had worsening disability trends. The UV analyses showed that all of the following factors were statistically relevant: age, educational level, number of major comorbidities, sleep disturbances and fatigue, RADAI and the use of TNF therapy. The final MV model included pain (OR: 1.003 (95%CI: (1.000; 1.005))), age (OR: 1.02 (1.01; 1.02)) and the use of TNF (OR: 0.94 (0.91; 0.97)).

Conclusions:

In our study, we showed that older age and more pain predicted worsening HAQ disability trends. The use of TNF therapy (with or without concomitant DMARDs) when compared with traditional DMARD was the only factor that decreased the odds of having a worsening HAQ trajectory.

To cite this abstract, please use the following information:
Pedro, Sofia, Benito-Garcia, Elizabeth, Vasconcelos, Joana, Chaves, Irina, Marques, Rita, Rodrigues, Andreia, et al; TNF Therapy Reduces the Odds of Worsening Disability Trajectories in Rheumatoid Arthritis over at Least 2 YearsData from the NDB-Portugal Cohort. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :89
DOI: 10.1002/art.27858

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