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Disability in rheumatoid arthritis in the era of biological treatments
  1. Eswar Krishnan,
  2. Bharathi Lingala,
  3. Bonnie Bruce,
  4. James F Fries
  1. Division of Rheumatology and Immunology, Stanford University Department of Medicine, Palo Alto, California, USA
  1. Correspondence to Dr Eswar Krishnan, Division of Rheumatology and Immunology, Stanford University Department of Medicine, Suite 203, 1000 Welch Road, Palo Alto, CA 94304, USA; arthritis.md{at}gmail.com

Abstract

Objective Rheumatoid arthritis (RA) is a disabling disease. The authors studied the impact of new, expensive and occasionally toxic biological treatments on disability outcomes in real-world populations of patients with RA.

Methods The authors analysed Health Assessment Questionnaire Disability Index data on 4651 adult patients with RA collected prospectively from 1983 to 2006. They studied trends in disability using multilevel mixed-effects multivariable linear regression (mixed) models that adjusted for the effects of time trends in gender, ethnicity, age, smoking behaviour and disease duration.

Results Overall, the patients were predominantly female (76%), were predominantly white (88%), had 13 years of education and have had RA for 13 years, on average. The time period from 1983 to 2006 saw major increases in the use of disease-modifying agents and biological agents, and a decrease in smoking. After adjustments, the disability rates declined at annual rates of 1.7% (1.5–1.8%) overall and 2.7% (2.4–3.1%) among men. The annual rate of disability declines in the biological era was greater than that in the preceding period, suggesting accelerated improvement. These declines were documented in all patient subgroups such as men, women, African–Americans, obese, older age groups and early disease (p<0.001), but not among the 1401 patients (where disability remained stable) who died on follow-up.

Conclusion Aggressive use of traditional disease-modifying agents and introduction of biological agents were associated with substantial gains in disability outcomes. Our finding supports the prevailing notion that ‘tight inflammation control’ is a desirable therapeutic strategy.

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Footnotes

  • Funding The study was funded by Centocor Ortho-Biotech (Horsham, Pennsylvania).

  • Competing interests The authors declare that they have no competing interests. The present analysis was performed using an investigator-initiated funding mechanism from Centocor Ortho-Biotech, whose products include biological treatments for RA.

  • Ethics approval The study was approved by the Stanford Institutional Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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