Background New paradigm of early and aggressive approach has led to better outcomes for RA especially documented from RCT. However, achieving remission/low disease in the real world can only be assessed by routine care registries in different populations, with different drug use.
Objectives We aimed to better define those patients not achieving low/remission disease levels, determine what factors may be playing a role in not achieving a low/remission disease activity level and compare US and Turkish (TR) patients.
Methods Consecutive patients seen at participating centers completed a MDHAQ at each visit. Physician global assessment VAS, tender and swollen joint counts, RAPID3, DAS28 and CDAI scores were also recorded. Demographics, self-reported disease activity measures, clinical data and medication usage were abstracted from the last visit of individuals with more than one visit. Linear regression was used to estimate continuous outcomes with disease severity adjusting for country; logistic regression was used for binary outcomes.
Results 162 TR (remission/low disease activity vs moderate/high disease activity 60/102) and 349 US (remission/low disease activity vs moderate/high disease activity 223/126) patients were analyzed. Patients with moderate/severe activity were older and less educated (both p<0.001). There was more hypertension, asthma and diabetes in moderate/severe disease groups (37%, 8%, 10% in TR and 22%, 11%, 7%, in US respectively) compared to remission/low disease activity groups (25%, 2%, 7% in TR, and 9%, 2%, 2% in US, respectively) (p<0.01). Extra-articular disease did not differ significantly between countries, but there was a statistically significant (p=0.013) increased prevalence of extra-articular disease associated with elevated disease activity. No differences were noted in erosions or smoking between remission/low disease activity and moderate/severe groups in either country. Patients with shorter disease duration were more likely to be in remission/low disease activity state. Both biologic (29% vs 20% in TR, 49% vs 37% in US, p=0.014) and corticosteroid use (58% vs 42% in TR, 39% vs 23% in US, p<0.001) were significantly higher in patients with moderate/severe disease activity.
Conclusions RA patients with moderate/severe disease activity in both countries were older, had more comorbidities and extra-articular disease. Despite receiving more aggressive treatment than patients in remission/low disease activity, still majority of those patients were not on biologic treatment probably leading to higher corticosteroid usage. Factors like comorbidities and extra-articular disease may be the cause of unwillingness to use biologic therapy where it is necessary.
Acknowledgements The authors would like to thanks Cortex for their help with data entry and Bristol-Myers Squibb for an unrestricted support for this project.
Disclosure of Interest None Declared
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