Background Rheumatoid arthritis (RA) is a chronic inflammatory joint disease affecting 0.5% of Spanish population. This disease results in a significant radiological and functional deterioration, decreasing the quality of life and increasing its mortality if an specific treatment is not applied. Although the radiological and functional deterioration progress slowly during the whole course of the disease, it has been proven that early and aggressive approach to the disease is important in order for its control because the final outcome can be improved with a close, intense and early follow-up.
Objectives To describe the clinical characteristics and evolution during 5 years of disease activity in RA patients derived from a recent arthritis clinic.
Methods A prospective longitudinal study was carried out of 154 patients diagnosed from 2003 to 2012. They included patients over 18 years old diagnosed with RA (ACR criteria 1987) and with 5 years of follow-up. Socio-demographic and clinical variables such as Rheumatoid factor (FR) and anti-citrullinated peptide antibodies (ACPA) or disease activity (DAS28-VSG) as well as treatment were assessed in those patients. Mean and standard deviation of quantitative variables and frequencies and percentages of qualitative variables were calculated. Proportions were compared using the Cochran Q test statistic in order to compare differences between remission (determined by DAS-28 <2.6) measured at 1 year, 2 years and 5 years from diagnosis. Data were analyzed using SPSS v17 program.
Results Of the 154 patients, 66.2% were females with a mean age at diagnosis of 52.88±14.64 years. Only 18.8% (29) patients were smokers; 67.5% (104) of patients were RF positive and 57% (88) of them were ACPA positive. Clinical remission measured by means of DAS 28-VSG (<2.6) was achieved in 84 patients (54.5%), 92 patients (59.7%) and 95 patients (61.7%) after 1, 2 and 5 years, respectively. Mean values of DAS 28 were 2.58 (2.02) at first year, 2.56 (1.99) at two years and 2.59 (2.02) at 5 years. Of the 154 patients, 108 (78.8%) started treatment with monotherapy (mostly methotrexate) and after 5 years only 18 (25.7%) patients were on biological treatment. No differences were found when remission was compared at first, second and 5 years of follow-up.
Subsequent comparison of two-to-two ratios among the three groups using χ2 contrast also indicated that there were no statistically significant differences between groups. However a tendency in data was observed, so that once patients had reached the remission at first year there was no increase in the number of them showing remission in the successive years of follow-up.
Conclusions These results suggest that achieving an early control of the disease is of importance, since control of the disease becomes more difficult as the delay of the diagnosis increases.
Villaverde Garcia V, Balsa A, Carmona L, Sanmartí R, Maese J, Pascual D, Ivorra J. What are patients with early rheumatoid arthritis like in Spain? Description of the PROAR cohort. Reumatología clínica.2009;5:115–120.
Disclosure of Interest None declared
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