Background Besides suppression of inflammation and prevention of radiographic damage, improvement of functional ability and Health Related Quality Of Life (HRQOL) is one of the main goals of treatment in patients with RA.
Objectives To investigate patient reported outcomes (PROs) of functioning and HRQOL after 1 year remission-steered treatment.
Methods 610 patients with early RA or undifferentiated arthritis (UA) were included in the IMPROVED-study. All started with methotrexate (MTX) and tapered high dose prednisone. Patients in early remission (Disease Activity Score (DAS)<1.6 after 4 months) tapered prednisone to 0 and when in remission after 8 months, also tapered MTX. Patients not in early remission were randomized to MTX plus hydroxychloroquine, sulphasalazine and prednisone (arm 1) or to MTX+adalimumab (arm 2). Every 4 months, patients filled out the McMaster-Toronto Arthritis Patients Preference Questionnaire (MACTAR) and the Health Assessment Questionnaire (HAQ) to measure functional ability, the Short Form 36 (SF-36) for mental en physical HRQOL and visual analogue scales (VAS). Scores were analyzed separately for all treatment arms and compared between arm 1 and 2. Predictors of HRQOL were identified using linear mixed models.
Results 387 patients achieved early remission and 221 patients did not; 83 patients were randomized to arm 1 and 78 to arm 2, 50 did not follow the protocol. After 1 year, remission was most often achieved by patients who were in early remission. Patients in arm 2 more often achieved remission (40%) than patients in arm 1 (25%). Except mental HRQOL, which was stable over 1 year and close to the population mean of 50 in all patients, all PROs and VAS results improved over 1 year, the most during the first 4 months (table). Only VAS disease activity improved significantly more in arm 2 (mean difference 13, 95%CI 2;23), other VAS scores were similar in both arms. The strongest independent predictor for HRQOL was baseline HAQ (beta for mental HRQOL:-1.8, 95%CI -2.8;-0.8, for physical HRQOL:-9.1, 95%CI -9.8;-8.4).
Conclusions In early arthritis patients functional ability and HRQOL improve after 1 year of remission targeted treatment, with the largest change in the first 4 months. Patients who achieve early remission improve the most, achieving functional ability and HRQOL in the normal range. In patients who did not achieve early remission, there was no difference in improvement after treatment with DMARD+prednisone or adalimumab+MTX although more patients achieved remission after 1 year in the latter group.
Disclosure of Interest None Declared