Background Rheumatoid arthritis is a chronic systemic disabling condition associated with pathology mainly of the peripheral joints. Quality of Life (QoL) encompasses the impact of the disease and its treatment on the ability of the patient to fulfill/satisfy his or her needs. Assessing QoL in RA is an attempt to ensure the concern of patients that this important aspect of their daily lives will be measured.
Objectives To evaluate the change of QoL of Bulgarian patients with RA after 6 months to 1-year of treatment with csDMARDs and bDMARDs by using two generic questionnaires (HAQ-DI and SF-36) and a disease-specific measurement RAQoL.
Methods A total of 220 patients with a mean age 55.05±10.63SD meeting the 1987 ACR classification criteria for RA were included in the study. The mean disease duration was 9.97±5.78SD. Patients were stratified according to treatment regimens into 2 age-matched treatment groups: 96 on csDMARDs and 124 on bDMARD therapy. Subjects with significant comorbidity, infectious disease, congestive heart failure (NYHA class III or IV), malignant hypertension, psychiatric illness, a history of lymphoproliferative disease or neoplasia were excluded from the study. All participants completed the HAQ-DI, SF-36v2TM and RAQoL at baseline, at months 6 and 12 thereafter. The scores of the three instruments were calculated via licensed calculator. Comparison was performed by analysis variance ANOVA.
Results At baseline the mean scores of HAQ-DI and RAQoL did not differ greatly among patients on csDMARDs and bDMARDs (1.29±0.78SD vs 1.13±0.54SD, p=0.063; 16.31±8.26SD vs 15.03±7.13SD, p=0.219, respectively). However, the mean physical component summary score of SF-36 was significantly higher in bDMARDs compared with csDMARDs (32.98±5.97 vs 31.05±7.82, p=0.039), while in the mental component of this scoring system not such a difference was found (p=0.983). After 6 months subjects treated with bDMARD showed a significant decreasing of the means of the HAQ-DI and RAQoL, as opposed to the other treatment group (0.86±0.5SD vs 1.17±0.76SD, p<0.001; 10.98±6.53SD vs 14.55±7.96SD, p<0.001 respectively). Similar results were obtained for both physical and mental component summary scores of SF-36 (39.49±6.43SD vs 33.48±8.04SD, p<0.001; 43.69±7,99SD vs 39.66±10.19SD, p=0.001 respectively). At month 12 a significant improvement of QoL, measured by the three assessment tools was registered in patient receiving bDMARDs compared with the csDMARD treatment group (p<0.001).
Conclusions Patient treated with bDMARDs showed better results for QoL than those on therapy with csDMARDs within a period of 12 months of treatment. Current management strategies should focus on improving the symptoms of activity and maintaining physical function in order to increase QoL in patients with RA.
Disclosure of Interest None declared