Background Functional health status declines and disability increases early in patients with RA, with half of affected patients developing moderate loss of functional ability within 2 years of diagnosis.1 Early initiation of aggressive treatment has been suggested as a means to improve long-term outcomes.
Objectives To evaluate the impact of early therapy with ENBREL on disability.
Methods In this analysis, we compared the improvement in Health Assessment Questionnaire (HAQ) disability scores over 2 years in 207 patients with early disease (mean duration of RA was 1 year) to 563 patients with long-standing disease (mean duration of RA 12 years) who were treated with 25 mg ENBREL SC twice weekly.
Mean baseline patient characteristics in the early vs. late groups were similar, including HAQ (1.5 vs 1.6), number of tender (31 vs 32) and swollen (24 vs 26) joints, CRP (3.3 vs 4.4 mg/dL), presence of RF (87% vs 81%), and age (51 vs 53 years). Patients with early disease had been treated with fewer DMARDS (0.5 vs 3.3).
Results Patients with both early and late RA achieved rapid and sustained clinical responses and improvement in HAQ scores, but the magnitude of improvement in HAQ was greater in patients with early disease. At 2 years, mean HAQ scores declined from 1.5 to 0.6 in the early RA group and from 1.6 to 1.0 in patients with established disease. The proportion of patients who achieved zero HAQ scores was greater for patients with early disease (29%) compared to patients with late disease (14%) (p < 0.001).
Conclusion While patients with early or long-standing disease had significant improvement in disability with ENBREL therapy, patients with early disease had greater benefit. Aggressive therapy in patients with early RA has greater potential to improve disability as measured by HAQ than in patients with more established disease who have failed multiple DMARDs.
Wolfe F. A Reappraisal of HAQ disability in rheumatoid arthritis. Arthritis Rheum. 2000;43:2751–61
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