RA Outcome Improved Over Last 20 Years

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RA Outcome Improved Over Last 20 Years

NEW YORK (Reuters Health) Apr 12 - The rates of hospitalization to treat

severe complications of rheumatoid arthritis (RA) declined between 1983 and

2001, according to Dr. M. Ward, an investigator at the US National

Institute of Arthritis and Musculoskeletal and Skin Diseases.

" These findings suggest that since the early 1980s, the long-term health

outcomes of patients with RA have improved, " he reports in the April issue

of Arthritis and Rheumatism.

The Bethesda, land-based researcher identified patients with RA age 40

or older using the data files of the California Office of Statewide Health

Planning and Development.

He abstracted data for manifestations that indicate severe disease and

failure of antirheumatic treatment to adequately control RA. The results

were adjusted for patient age, gender and ethnicity, and reported as rates

per 100,000 persons with RA.

For the period from 1983 to 1987, there were 148.7 hospitalizations for

rheumatoid vasculitis per 100,000 patients with RA. This declined to 97.8

for the period between 1998 and 2001 (p < 0.0001). Corresponding rates for

splenectomy to treat Felty's syndrome were 6.1 and 1.8 (p = 0.0001).

There was a trend toward increasing rates of total knee arthroplasty between

1983 and 1997, but this reversed between 1997 and 2001. Dr. Ward describes

this as " particularly noteworthy, " since the rates of knee arthroplasty more

than doubled between 1998 and 2000 among Medicare recipients overall.

Hospitalization rates for stroke and atrial fibrillation approximately

doubled between the earliest and the latest periods (p < 0.0001). While this

is a concern, Dr. Ward notes, the data suggest that " the decreased rates of

hospitalization for manifestations of severe RA were not due to changes in

the use of hospital care from 1983 to 2001, but rather were specific to

manifestations of RA. "

These data are consistent with the effect of increased use of

disease-modifying medications in the late 1980s and early 1990s, he adds.

However, the decrease predated the widespread use of biologic antirheumatic

medications.

As these medications are used more often and " more consistently throughout

the course of the disease, further improvements in the health outcomes of

patients with RA might be anticipated, " Dr. Ward concludes.

Arthritis Rheum 2004;50:1122-1131.