Background During the past decade there has been an increasing focus on early, aggressive treatment, and combined with the availability of biologicals this will likely lead to improved outcomes in patients (pts) with RA. Observational data reflect everyday clinical practice and can provide information about implementation of current treatment recommendations.
Objectives To investigate whether baseline disease activity levels and responses in pts with RA changed during the period 2001-2010.
Methods Data for this study were provided by the NOR-DMARD register. Adult pts with inflammatory arthropathies starting a new DMARD at five Norwegian rheumatology departments are consecutively included and followed longitudinally. For these analyses methotrexate (MTX) naïve RA pts starting MTX monotherapy (MTX mono), and biological naïve RA pts starting TNFi + MTX (TNFi+MTX) were included. For the descriptive analyses each group was stratified into two-year intervals according to start date. Time trends in several baseline variables were assessed by linear regression analysis with time as the independent variable (continuous 1-10) and the respective baseline variables as dependent variables. CRP, ESR, joint counts and MHAQ were normalised for the linear regression analyses. EULAR good response and DAS28 remission were similarly assessed by logistic regression analysis.
Results A total of 2573 pts (MTX mono n=1866, TNFi+MTX n=707) were included [70% female, 64% RF+, mean (SD) age 55.0 (13.7) years, disease duration 5.1 (8.5) years]. Significant time trends were found in both groups for baseline values of DAS28, 28-SJC and CRP (table). Significant time trends were found for baseline disease duration, SDAI, MHAQ, 28 TJC, ESR, physician global, patient global and joint pain VAS (data not shown). There was also a time trend showing increasing DAS28 remission rates at 6 months in both groups, whereas a time trend for increasing rates of EULAR good response was only observed for the MTX mono group (table).
Conclusions These data show that the mean baseline disease activity level when starting MTX treatment and the first TNFi have decreased from high to moderate disease activity. Disease duration when initiating treatment has also decreased significantly. This indicates that clinicians have implemented modern, more aggressive RA treatment strategies which will hopefully result in better long-term patient outcomes.
Disclosure of Interest A.-B. Aga Consultant for: UCB, E. Lie: None Declared, K. Fagerli: None Declared, T. Uhlig: None Declared, T. Kvien: None Declared, E. Haavardsholm: None Declared
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