Background Patient focussed therapy in rheumatoid arthritis should meet the needs of the patients. From the perspective of the patient with rheumatoid arthritis control of symptoms and the prevention of disability are key indicators of successful treatment. We still find patients in our clinical practice who in spite of maximal DMARD therapy remain in a medium disease activity state. These patients tend to have poor functional outcomes.
Objectives To examine the effect of management of rheumatoid arthritis with anti TNF agents compared to traditional DMARDs in determining the functional outcomes in a cohort of patients over a period of 18 months.
Methods 144 patients from the RA centre database were retrospectively selected over a 3 year period. The selected patients had either High Disease Activity Score on biologic therapy(anti TNF alpha therapy) or had moderate disease activity on maximal non biological DMARD therapy and in whom we had data pertaining to clinical, laboratory data and functional outcomes for most of the period of assessment. Functional outcome and hence disability was assessed by HAQ-DI (Health Activity Questionnaire-Disability Index). The end point was change in HAQ-DI in patients with high disease activity receiving TNF blocker therapy compared to those with moderate disease activity on stable DMARD therapy. SPSS software was used to carry out statistical analysis. Correlation between numerous baseline variables and HAQ score in the end were analysed using non parametric tests. Multiple linear regression analysis was carried out to select factors affecting HAQ progression in the population and to assess factors affecting mean HAQ scores in all patients. Changes in DAS28 and HAQ in both subgroups were analysed (mean and standard error).
Results Baseline features of the population: Mean age 57.52 years. Female 110(76%), Male34(24%),Mean RA duration 10.51years(TNF subgroup 11.25years, DMARD subgroup 9.73 years), Mean initial DAS28 5.04(TNF subgroup 5.92 DMARD subgroup 4.13), Mean initial HAQ 1.593(TNF subgroup 1.81 DMARD subgroup 1.36), mean final HAQ 1.372(TNF subgroup- 1.46 DMARD subgroup 1.29).
The study showed a significant fall in the mean HAQ in the anti-TNF treated population at the end of 18 months compared to baseline. Functional improvement (as evidenced by the fall in mean HAQ at 18months compared to baseline) is three times more in the early RA patient subgroup (-0.77) compared to the fall in those patients with established RA (-0.26) treated with anti TNF agents.
Initial DAS28, age and sex were found to be the significant factors affecting mean HAQ scores by multiple linear regression analysis after adjusting for all the covariates. It was also noted that initial HAQ and use of TNF inhibitors had a significant correlation with progression of HAQ (adjusted B-0.16, p<0.001).
Fewer patients on anti TNF therapy required regular steroids compared to those on non-biological DMARDs. Greater number of patients on biologic therapy remained in remission compared to those on non biological DMARDs.
Conclusions Early aggressive treatment resulted in significant improvement in patients with RA. In this cohort of patients with RA keeping disease activity low with appropriate management was associated with significant improvement in functional outcomes.
Disclosure of Interest None Declared