Background While rheumatoid arthritis (RA) patients are often identified at an early stage, limited data are available on their clinical status while in the moderate stage. Prior work  underlines the need to characterize moderate RA patients prior to biologic therapy initiation.
Objectives To describe the moderate RA population in terms of patient characteristics, disease status, treatment profile prior to biologic therapy initiation and health-related quality of life (HRQOL).
Methods Subjects were recruited to a UK longitudinal cohort study 2001-2009 which compared a non-biologic treated group (nBG) exposed to at least one traditional DMARD to a biologic group (BG) treated with etanercept (ETN). A subset of patients aged ≥18 years with moderate RA (3.2<DAS28≤5.1) were analyzed. Anonymous data were provided by the British Society for Rheumatology Biologics Register (BSRBR). HRQOL was assessed using the Health Assessment Questionnaire (HAQ) disability index score and SF-36 [physical component score (PCS), mental component score (MCS)]. Baseline characteristics were assessed using the t-test, chi-squared test or Fisher’s exact test.
Results 1754 patients were assessed (211 BG/1543 nBG). nBG patients were significantly less likely to be unemployed due to disability but more likely to smoke. History of angina and liver disease were shown to differ across groups. Patients had RA for an average of 10.7 years with the BG displaying longer disease duration. The BG tended towards higher disease activity, demonstrated with higher tender joints, swollen joints and DAS28 scores compared to nBG. A higher proportion of BG patients had systemic features and joint replacement compared to the nBG, BG patients had significantly lower HRQOL, higher HAQ and lower PCS.
Conclusions In moderate RA patients from a clinical practice registry, those treated with a biologic (ETN) had higher disease activity, more work disability, lower HRQOL at time of biologic initiation compared to nBG. Comorbidities were generally less in the BG possibly suggesting that biologic medications were channelled away from the nBG. This demonstrates the burden of illness on the moderate RA patient population and highlights the expected higher severity of RA at time of biologic therapy initiation. Future work should assess change over time to assess the impact of biologic therapy on moderate RA patients.
Hyrich K, Deighton C. et al. Benefit of anti-TNF therapy in rheumatoid arthritis patients with moderate disease activity. Rheumatology 2009;48:1323–1327.
Disclosure of Interest S. Kotak Shareholder of: Pfizer, Employee of: Pfizer, J. Mardekian Shareholder of: Pfizer, Employee of: Pfizer, N. Horowicz-Mehler Consultant for: Pfizer, A. Shah Consultant for: Pfizer, A. Burgess Consultant for: Pfizer, J. Kim Consultant for: Pfizer, E. Gemmen Consultant for: Pfizer, H. Boyd Employee of: Pfizer, A. Koenig Shareholder of: Pfizer, Employee of: Pfizer