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Have the 10-year outcomes of patients with early inflammatory arthritis improved in the new millennium compared with the decade before? Results from the Norfolk Arthritis Register
  1. James M Gwinnutt1,
  2. Deborah P M Symmons1,
  3. Alexander J MacGregor2,3,
  4. Jacqueline R Chipping2,3,
  5. Tarnya Marshall2,3,
  6. Mark Lunt1,
  7. Suzanne M M Verstappen1,4
  1. 1 Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
  2. 2 Rheumatology Department, Norfolk and Norwich University Hospitals NHS Trust, Norwich, UK
  3. 3 Norwich Medical School, University of East Anglia Faculty of Medicine and Health Sciences, Norwich, UK
  4. 4 NIHR Manchester Biomedical Research Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
  1. Correspondence to Dr Suzanne M M Verstappen, Arthritis Research UK Epidemiology Unit, University of Manchester, Manchester M13 9PT, UK; Suzanne.Verstappen{at}


Objective To compare the 10-year outcome (disease activity, disability, mortality) of two cohorts of patients with inflammatory polyarthritis (IP) recruited 10 years apart.

Methods Patients with IP were recruited to the Norfolk Arthritis Register from 1990 to 1994 (cohort 1 (C1)) and from 2000 to 2004 (cohort 2 (C2)). Demographic and clinical data were collected at baseline and at years 1, 2, 3, 5, 7 and 10. Longitudinal disease activity (swollen/tender 51 joint counts (SJC51/TJC51)) and disability (Health Assessment Questionnaire (HAQ)) were compared between the cohorts using population-average negative binomial regression and generalised estimating equation analysis, respectively. Risk of 10-year mortality was compared between cohorts using Cox models. Risk of cardiovascular disease (CVD) mortality was compared between cohorts using competing risks analysis. Mortality rate ratios (MRR), adjusted for changes in mortality risk of the general population, were calculated using Poisson regression.

Results In total 1653 patients were recruited (C1=1022, C2=631). Patients in C2 had 17% lower SJC51 than C1 over 10 years (95% CI −23% to −10%), whereas TJC51 and HAQ were comparable. C2 patients had reduced risk of all-cause and CVD mortality compared with C1 (all-cause: HR 0.72, 95% CI 0.56 to 0.95; CVD: subhazard ratio 0.58, 95% CI 0.37 to 0.93). After accounting for changes in mortality risk in the general population, the difference in mortality was non-significant (all-cause: MRR 0.78, 95% CI 0.56 to 1.10; CVD: MRR 0.77, 95% CI 0.48 to 1.24).

Conclusion Disease activity significantly improved in the new millennium, whereas disability and mortality were unchanged.

  • early rheumatoid arthritis
  • outcomes research
  • epidemiology
  • disability
  • mortality

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  • Handling editor Josef S Smolen

  • Contributors Review of manuscript: JMG, DPMS, AJM, JRC, TM, ML, SMMV. Study concept and design: JMG, DPMS, ML, SMMV. Acquisition of data: JMG, JRC, TM. Analysis and interpretation of the data: JMG, DPMS, ML, SMMV.

  • Funding NOAR is funded by Arthritis Research UK (grant reference numbers 20380, 20385 and 21229).

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval The study was approved by the Norfolk and Norwich University Hospital Local Research Ethics Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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