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Study: Early treatment of RA shows benefits 20 years later
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Early treatment of rheumatoid arthritis within the first 6 months of symptom onset can lead to improved health outcomes 20 years later, according to an analysis of arthritis prognosis.
Suzanne M.M. Verstappen, PhD, at the University of Manchester in the United Kingdom, and colleagues included 602 patients diagnosed with rheumatoid arthritis between 1990 and 1994 and who met the 2010 American College of Rheumatology diagnosis criteria. After 20 years, 207 patients remained for follow-up.
Investigators found there was an increased risk for death in men (ratio = 1.47), as well as in patients who were older when their symptoms began to appear (ratio = 1.1 per year), those who were smoking at baseline (ratio = 1.65) and those who smoked before the study (ratio = 1.82). Of patients who received treatment within 6 months of symptom onset, 55% died during the 20 years compared with 39.8% for those who received treatment after 6 months and 40.4% who received no treatment. After adjustment for age, gender and confoundment by indication, investigators found a slight — yet non-significant — decrease in risk for death in the early treatment group. However, there was no difference between early treatment (beta score = 0.03) and no treatment (beta score = 0), according to results of the British version of the health assessment questionnaire disability index (HAQ-DI) score, which measures “functional disability” on a score from 0 to 3.
Despite this, late treatment still had higher HAQ disability scores compared with no treatment (beta score = 0.10), even after investigators adjusted for age, gender, rheumatoid factor, anti-citrullinated protein antibody levels, smoking status, HAQ, swollen joint count, tender joint count and C-reactive protein levels at baseline — which suggested early treatment can lead to improved outcomes, even into the second decade after symptoms first appear.
“In the early 1990s, when this study started, only 30% of patients received early treatment, but this number has increased significantly in the last decade,” Verstappen said in a press release. “It is 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.” – by Will A. Offit
Disclosures: The researchers report they received funding by the Arthritis Research UK.
Image Credit: University of Manchester.
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