Article Text
Abstract
Objectives To examine the association between disease activity in early rheumatoid arthritis (RA), functional limitation and long-term orthopaedic episodes.
Methods Health Assessment Questionnaire (HAQ) disability scores were collected from two longitudinal early RA inception cohorts in routine care; Early Rheumatoid Arthritis Study and Early Rheumatoid Arthritis Network from 1986 to 2012. The incidence of major and intermediate orthopaedic surgical episodes over 25 years was collected from national data sets. Disease activity was categorised by mean disease activity score (DAS28) annually between years 1 and 5; remission (RDAS≤2.6), low (LDAS>2.6–3.2), low-moderate (LMDAS≥3.2–4.19), high-moderate (HMDAS 4.2–5.1) and high (HDAS>5.1).
Results Data from 2045 patients were analysed. Patients in RDAS showed no HAQ progression over 5 years, whereas there was a significant relationship between rising DAS28 category and HAQ at 1 year, and the rate of HAQ progression between years 1 and 5. During 27 986 person-years follow-up, 392 intermediate and 591 major surgeries were observed. Compared with the RDAS category, there was a significantly increased cumulative incidence of intermediate surgery in HDAS (OR 2.59 CI 1.49 to 4.52) and HMDAS (OR 1.8 CI 1.05 to 3.11) categories, and for major surgery in HDAS (OR 2.48 CI 1.5 to 4.11), HMDAS (OR 2.16 CI 1.32 to 3.52) and LMDAS (OR 2.07 CI 1.28 to 3.33) categories. There was no significant difference in HAQ progression or orthopaedic episodes between RDAS and LDAS categories.
Conclusions There is an association between disease activity and both poor function and long-term orthopaedic episodes. This illustrates the far from benign consequences of persistent moderate disease activity, and supports European League Against Rheumatism treat to target recommendations to secure low disease activity or remission in all patients.
- Rheumatoid Arthritis
- Disease Activity
- Treatment
- DMARDs (biologic)
- DMARDs (synthetic)
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Footnotes
Handling editor Tore K Kvien
Twitter Follow Elena Nikiphorou at @ElenaNikiUK
Collaborators ERAS: Dr Paul Davies & Lynn Hill (Chelmsford), Dr Andrew Gough, Dr Joe Devlin, Prof. Paul Emery & Lynn Waterhouse (Birmingham), Dr David James & Helen Tate (Grimsby), Dr Peter Prouse & Cathy Boys (Basingstoke), Dr Peter Williams & Dora White (Medway), Helen Dart (Oswestry), Dr Nigel Cox & Sue Stafford (Winchester), Dr John Winfield (Sheffield), Annie Seymour (St Albans). ERAN: Annie Seymour (City Hospital, St Albans), Dr Richard Williams, Karina Blunn & Jackie McDowell (Hereford County Hospital), Dr Peter Prouse and Sheryl Andrews (North Hampshire Hospital), Deborah Wilson (King's Mill Hospital), Dr Malgorzata Magliano & Ursula Perks (Stoke Mandeville Hospital), Dr Amanda Coulson (Withybush General Hospital), Dr Andrew Hassle & Michele Kirwan (Haywood Hospital), Francesca Leone (St George's Hospital), Dr Ciaran Dunne & Lindsey Hawley (Christchurch Hospital), Dr Paul Creamer, Julie Taylor & Wendy Wilmott (Southmead Hospital), Dr Sally Knights & Rebecca Rowland-Axe (Yeovil District Hospital), Dr Sandra Green & Dawn Simmons (Weston-Super-Mare General Hospital), Dr Joel David & Maureen Cox (Nuffield Orthopaedic Centre), Dr Marwan Bukhari & Bronwen Evans (Lancaster Royal Infirmary), Dr Michael Batley & Catherine Oram, (Maidstone Hospital), Dr Tanya Potter (Coventry University Hospital). The authors acknowledge the Office of National Statistics, the Medical Research Information Service and Health & Social Care Information Service as well as Hospital Episode Statistics and the National Joint Registry for providing the orthopaedic episode data.
Contributors Study conception: EN, SN, AY and PK. Analysis: EN and SN. Statistical expertise: SN and LC. Data interpretation: EN, SN, LC and PK. Drafting of article: EN, SN and PK. Critical revision of article: EN, SN, AY, LC, JD, DAW and PK. Final approval of article: EN, SN and PK.
Funding ERAS received grants from the Arthritis Research Campaign and the British United Providence Association Foundation and is supported by the National Institute for Health Research Clinical Research Network (CLRN) Essex & Hertfordshire. ERAN received funding from the British Society of Rheumatology and a grant from the Healthcare Commission. Elena Nikiphorou received a grant from the Essex & Hertfordshire CLRN.
Competing interests None declared.
Ethics approval The ERAS study received ethical approval from the West Hertfordshire Local Research Ethics Committee and subsequently from the Caldicott Guardian. The ERAN study received ethical approval by the Trent Research Ethics Committee.
Provenance and peer review Not commissioned; externally peer reviewed.