Arthritis & Rheumatism, Volume 63,
November 2011 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Chicago, Illinois November 4-9, 2011.


Rheumatoid Arthritis Continues to Improve in the New Millennium Whilst Use of Medication Change. Findings From a Representative Rheumatoid Arthritis Register Over 15 Years.

Austad,  Cathrine, Kvien,  Tore K., Uhlig,  Till

Background/Purpose:

During recent years and especially in the new millennium disease severity in patients with rheumatoid arthritis (RA) has been reported improved. It is important to retrieve such information from population based studies and to identify trends over time for this improvement. Purpose: To explore whether observed improved RA severity as measured by patient reported outcomes (PROs) improves over a perspective of 15 years and in the most recent years after introduction of biologic therapies.

Methods:

In a population based registry of RA, 868 patients aged 20–79 years (mean (SD) age 59.9 (12.3) years, disease duration 13.0 (10.8) years, 77.1% females, 57.0 % RF+ or CCP+) responded in 2009 to a mailed questionnaire (response rate 60.6%). The PROs included pain, fatigue and patient global assessment of disease impact on 100 mm visual analogue scales, modified HAQ, SF-36 (with calculation of physical (PCS) and mental component summary (MCS) (low scores=poor health), and SF-6D derived utility). Patients reported use of medications including disease modifying anti-rheumatic drugs (DMARDs).

Results are given with means and 95% confidence intervals (CI), and were compared with outcomes from previous cross-sectional health status surveys using the same instruments in 1994, 1996, 2001, and 2004. Comparisons across these cross-sectional data collections can be performed since the respondents are considered representative for the entire RA population in the geographic area [1]. Non-overlapping CI of a PRO at different time points was considered to represent a true difference. Subanalyses were performed to investigate differences in gender, disease duration <= or > 10 years and current use/non-use of DMARDs.

Results:

Age, gender and disease duration were similar at all examination points. Use of DMARDs increased from 36.4% in 1994 to 59.6% in 2009, both overall and for genders separately. DMARD users were statistically significant younger than non-users, data not included, with gender distribution equal that of the registry. In 2009 20% of patients used a biological DMARD. A consistent improvement in health status was observed from 1994 to 2009, except for mental health (see table). MHAQ and SF-36 PCS demonstrated a clear improvement from 2004 to 2009. Mean improvements from 1994 to 2009 were in the magnitude of what is considered as minimum clinically important.

 19941996200120042009
Current DMARD n(%)
Overall339 (36.4)407 (39.6)373 (45.0)495 (54.2)588 (59.6) MHAQ (1–4)
Overall1.68 (1.64; 1.71)1.65 (1.62; 1.69)1.58 (1.54; 1.62)*1.55 (1.51; 1.58)*1.44 (1.40; 1.47)*
Male1.48 (1.41; 1.54)1.52 (1.44; 1.60)1.44 (1.38; 1.51)1.49 (1.42; 1.57)1.38 (1.32; 1.44)
Female1.74 (1.69; 1.78)1.69 (1.65; 1.73)1.62 (1.58; 1.66)*1.56 (1.52; 1.60)*1.45 (1.41; 1.48)*
Dis. dur <= 10 years1,53(1.49; 1.57)1.50 (1.46; 1.54)1.44 (1.39; 1.48)*1.43 (1.38; 1.47)*1.34 (1.30; 1.37)*
Dis. dur >10 years1,86 (1.79; 1.92)1.81 (1.75; 1.86)1.70 (1.65; 1.76)*1.65 (1.60; 1.70)*1.50 (1.46; 1.55)*
Use DMARDs1,64 (1.58; 1.70)1.64 (1.58; 1.69)1.55 (1.50; 1.60)1.53 (1.48; 1.57)*1.42 (1.38; 1.46)*
No DMARDs1.70 (1.65; 1.75)1.67 (1.62; 1.72)1.61 (1.56; 1.66)1.57 (1.52; 1.62)*1.45 (1.40; 1.50)*VAS patient global (0–100)
Overall48.5 (47.0; 50.0)44.8 (43.5; 46.2)*39.8 (38.1; 41.6)*38.2 (36.6; 39.8)*37.1 (35.4; 38.8)*
Male50.7 (49.0; 52.4)40.6 (37.4; 43.7)*32.2 (28.8; 35.7)*34.4 (30.9; 37.8)*34.7 (31.4; 38.0)*
Female44.4 (40.8; 47.9)46.0 (44.4; 47.6)41.9 (39.9; 44.0)39.2 (37.4; 41.1)37.4 (35.6; 39.1)*
Dis.dur <= 10 years45.9 (43.7; 48.0)40.5 (38.5; 42.5)*34.8 (32.4; 37.3)*34.0 (31.6; 36.3)*33.8 (31.4; 36.2)*
Dis.dur >10 years53.4 (51.1; 55.6)49.1 (47.1; 51.1)44.0 (41.6; 46.5)*41.8 (39.6; 44.0)*39.1 (37.0; 41.2)*
DMARDs48.3 (45.6; 50.6)44.9 (42.8; 47.0)38.9 (36.4; 41.3)*37.8 (35.7; 39.9)*36.9 (34.9; 38.9)*
No DMARDs49.9 (47.8; 52.0)45.0 (43.1; 46.9)*40.6 (38.1; 43.1)*38.7 (36.2; 41.2)*36.6 (34.1; 39.1)*
SF-36 MCS (0–100)46.3 (45.5; 47.2)45.3 (44.5; 46.0)47.0 (46.2; 47.9)*47.5 (46.7; 48.3)46.9 (46.1; 47.7)*
SF-36 PCS (0–100)31.4 (30.7; 32.2)32.0 (31.3; 32.7)32.7 (31.9; 33.5)33.7 (32.9; 34.4)*36.4 (35.6; 37.2)*
SF-6D utility (0–1)0.616 (0.607; 0.625)0.617 (0.608; 0.625)0.639 (0.629; 0.649)*0.647 (0.638; 0.656)*0.670 (0.660; 0.680)*
Pain (0–100)46.0 (44.4; 47.5)*37.7 (36.2; 39.1)*35.8 (34.1; 37.4)*34.5 (33.0; 36.1)*34.2 (32.6; 35.8)*
Fatigue (0–100)50.0 (48.2; 51.8)44.1 (42.3; 45.9)*46.9 (44.9; 48.9)46.1 (44.2; 48.1)44.7 (42.8; 46.6)
*non-overlapping 95% CI with >=1 other measure

Conclusion:

The improvement in physical health and utility observed in 1994–2004 continued until 2009. Improvements were seen in both genders, with short and long disease duration, and independently of DMARD use. RA patients during the last 15 years had consistently reduced disability and better overall health and utility score, indicating that recent investments in health care for patients with RA are justified.

To cite this abstract, please use the following information:
Austad, Cathrine, Kvien, Tore K., Uhlig, Till; Rheumatoid Arthritis Continues to Improve in the New Millennium Whilst Use of Medication Change. Findings From a Representative Rheumatoid Arthritis Register Over 15 Years. [abstract]. Arthritis Rheum 2011;63 Suppl 10 :128
DOI:

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