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Disease Burden for RA, OA Similar at First Visit, Greater in OA at 6 Months
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Although disease burden, as measured by health assessment questionnaires, is similar among patients with osteoarthritis and rheumatoid arthritis at the time of initial visit, those with osteoarthritis demonstrate greater burden scores 6 months later, according to data published in Arthritis & Rheumatology.
“OA traditionally has been regarded as a result of ‘wear and tear,’ with far fewer consequences to patients compared to RA,” Theodore Pincus, MD, of Rush University Medical Center, told Healio Rheumatology.
“That may be the case for some patients, and possibly for most patients in the past,” he noted. “At this time, however, OA [disease burden] appears as severe as RA at the first visit to a rheumatologist, according to scores on a multidimensional health assessment questionnaire (MDHAQ) including the RAPID3 composite within the MDHAQ to assess patient disease burden.”
To compare disease burden in individuals with OA and RA at initial visit and during 6 months of follow-up, Pincus and colleagues analyzed rheumatology patients at Rush University Medical Center, including 149 with OA and 203 with RA. All participants completed the MDHAQ at all visits.
The researchers compiled MDHAQ scores for physical function, pain and patient global assessment into RAPID3, as well as additional scales, and compared the information for patients with RA and OA at baseline and 6 months. In addition, patients with either condition were group based on whether they were self- or physician-referred, and whether those with RA had previously used disease-modifying antirheumatic drugs. These groups were compared using ttests and analysis of variance, adjusting for age, disease duration, BMI, education and ethnicity.
According to the researchers, mean RAPID3 scores were not significantly different between patients with OA and those with RA who were DMARDnaive, whether self or physician-referred (P = .38). In addition, there were no significant difference in RAPID3 scores between patients with OA and those with RA who were DMARDnaive vs. those who had previously used DMARDs (P = .49). However, after 6months, RAPID3 scores improved substantially more among participants with RA compared with those with OA. The researchers reported similar findings for most selfreported measures, as well as in adjusted analyses.
“All health professionals, including primary care physicians, orthopedists, rheumatologists, physical therapists, occupational therapists, pharmacists and others must take symptoms of OA as seriously as symptoms of RA,” Pincus said. “A clear need exists to develop therapies to better prevent and manage the symptoms of OA.”
“The same MDHAQ is informative in all rheumatic diseases in which it has been studied to date, and can be used effectively to compare disease burden in different diseases,” he added. “These data were gathered without any grant support from completion of a MDHAQ by each patient at each visit in routine care data as an adjunct to clinical decisions in patient management. Similar approaches in any clinical setting can facilitate further recognition of disease burden in individual patients in clinical settings, in patient groups for clinical research, and to provide guidance for public health priorities.” – by Jason Laday
Disclosure: Pincus reports a copyright and trademark on MDHAQ and RAPID3, for which he receives royalties and license fees. Please see the study for all other relevant financial disclosures.
Perspective
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David A. McLain, MD, FACP, FACR
The senior researcher on this article, Theodore Pincus, MD, is the same rheumatologist that years ago showed us that mortality in rheumatoid arthritis was premature in comparison to the general population and the same as stage 4 lymphoma and 3 vessel coronary artery disease. This revelation at the time of the introduction of methotrexate, a cancer chemotherapy drug for RA, was instrumental in having rheumatologists realize that RA was a deadly serious condition that required aggressive treatment.
In the latest study, the Rush Medical Center rheumatology researchers compared the disease burden of osteoarthritis to rheumatoid arthritis using MDHAQ/RAPID3 that have been previously validated. Past studies had shown that patients with osteoarthritis, seen by rheumatologists, have had increased morbidity, mortality and costs associated with the disease. In the present study, the researchers used the same disease measurements on both RA and OA patients, which was rarely done in the past with the WOMAC (Western Ontario McMaster OA Index) used for OA functional status measurement.
Their hypothesis was that the disease burden was similar in OA and RA patients but worse in OA 6 months later — which is, in fact, what they found. However, an unexpected finding was the same physician referral rate for OA as DMARD-naïve RA patients; this may indicate a bias towards more severe OA at a tertiary referral center, but the same could be said for RA as well.
Another interesting finding was that the number of joints identified by OA patients was only slightly lower than the RA patients: In other words, OA patients see their disease almost as polyarticular as RA patients. This study has shown a similar or greater disease burden in OA patients when compared to RA patients, which decreased in all 3 groups but was significantly better with RA than OA. The researchers feel this reflects the superior treatments for RA vs. the treatments available for OA. The OA patients were also significantly older, heavier, and had a longer duration of disease. The researchers note that while, as rheumatologists, we see a significant difference between OA and RA patients due to the pathophysiology and treatments, from the patients’ perspective, the disease burden is similar.
The researchers also note that RA may have been worse in the past than OA but this may be changing by a trend towards milder RA, better community care of RA, earlier referral of RA, and a worsening of OA as patients live longer. Again, Dr. Pincus has exposed another rheumatology urban myth regarding the disease burden of OA vs. RA by finding a similarity in disease burden between the two groups in this study.
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