Background Severe long-term consequences of rheumatoid arthritis (RA) are well known, while the existing evidence suggests that early and active use of disease modifying anti rheumatic drugs (DMARDs) may improve the outcomes.
Objectives To study the impact of disease on the outcomes of patients with RA, and to describe their use of DMARDs over time.
Methods In August 2000, a questionnaire was sent to 1500 patients with RA who had been seen in Jyvaskyla Central Hospital since 1995 and were included in the RA database of the hospital. A total of 1093 (73%) patients replied and were included in the study. The overall impact of RA was assessed by asking “How much does RA impact your life?”. Response alternatives were 1)”Not at all”, 2)”Some”, 3)”Much”, and 4)”Very much”. The questionnaire also assessed functional capacity by Health Assessment Questionnaire (HAQ, range 0–3), pain and general health by 10 cm visual analogue scale (VAS, range 0–100), and current usage of DMARDs. Data concerning demographics, “diagnostic delay”, and previous use of DMARDs were available through the RA database. The intensity of the use of DMARDs was calculated as the percentage of the time on DMARDs from the total time elapsed since the diagnosis to August 2000.
Results A total of 13% of the patients did not experience any impact from RA, while 48% experienced “some”, 27% “much”, and 12% were impacted “very much”. Those experiencing “very much” level of impact by RA were older, had longer disease duration, had less education, were more often rheumatoid factor positive, had worse HAQ and general health scores, had more pain, and also had longer diagnostic delay, and less use of DMARDs over time than those experiencing “no” or “some” impact by the disease (Table 1: mean values for variables are shown except median for DMARD%.)
Conclusion In spite of extensive therapy with DMARDs, RA causes considerable impact in the majority of patients in the long term. Shortening of diagnostic delay (improvement in the cooperation between primary and specialist care) and continuous active therapy with available DMARDs should be emphasised to decrease disease impact.
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