Studies examine rheumatoid arthritis patients' prognosis

April 20, 2017 , Wiley

What's the long-term outlook for today's patients with early rheumatoid arthritis? A new study in Arthritis & Rheumatology that looks at patients' mortality, disease activity, and physical function over the course of 20 years reveals the importance of early treatment. Another study in the journal notes that deaths from arthritis are declining.

Investigators led by Suzanne Verstappen, PhD, of The University of Manchester in the UK, analyzed information on 602 from the Norfolk Arthritis Register who were recruited from 1990 to 1994. The team collected demographic variables and assessed (swollen/tender joint counts), disability, and mortality at various time points over 20 years.

Overall, patients had relatively low levels of disease activity from year one onwards, but disability rose to above baseline levels after seven years. This disability was moderate, however, indicating that patients experienced relatively good long-term outcomes, particularly compared with patients from earlier decades.

Patients who received treatment within six months after symptom onset had similar levels of disability over the subsequent 20 years as patients who were judged by clinicians to not require treatment. A total of 265 patients (44 percent) died, and, although not significant, there was a trend indicating that patients who received treatment within the first six months had a lower risk of than those who did not receive treatment, after controlling for disease severity.

"This research emphasizes the importance of early treatment and the long-term benefits of early treatment," said Dr. Verstappen. "In the early 1990s, when this study started, only 30 percent of patients received early , but this number has increased significantly in the last decade. 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."

Another analysis in the journal notes that deaths attributable to rheumatoid arthritis have declined in recent years. After examining information from 31 countries, investigators found that there are substantial between-country disparities in rheumatoid arthritis mortality, but the disparities have decreased over time.

According to data from the World Health Organization, rheumatoid arthritis was registered as the underlying cause of death in 8428 cases in 2011 (0.09% of all-cause deaths), a considerable drop compared with the 9281 cases (0.12% of all-cause deaths) in 1987. The age-standardized mortality rate of rheumatoid arthritis declined by 3.0% annually from 1987 to 2011.

Population aging combined with fewer deaths from rheumatoid arthritis may lead to an increased economic burden of the disease.

"Although increased survival with rheumatoid is great news, it might lead to a greater share of our aging population having the disease and in need of health services. This needs to be accounted for in health care planning", said lead author Aliasghar Kiadaliri, PhD, of Lund University in Sweden.

More information: James M Gwinnutt et al, The 20 year outcome and association between early treatment and mortality and disability in an inception cohort of patients with rheumatoid arthritis: Results from the Norfolk Arthritis Register, Arthritis & Rheumatology (2017). DOI: 10.1002/art.40090

Aliasghar A Kiadaliri et al. Rheumatoid arthritis as underlying cause of death in 31 countries, 1987-2011: Trend analysis of WHO mortality database, Arthritis & Rheumatology (2017). DOI: 10.1002/art.40091

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