RESEARCH - Trends toward milder disease in RA are attributable to improved therapy

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Ann Rheum Dis. 2006 Mar 15; [Epub ahead of print]

Progression of radiographic joint damage in different eras. Trends towards

milder disease in Rheumatoid Arthritis are attributable to improved therapy.

Finckh A, Choi HK, Wolfe F.

University of Geneva, Switzerland.

OBJECTIVE: Severity of rheumatoid arthritis (RA) and radiographic joint

damage progression has decreased over the last decades. The aim of this

study was to examine whether this trend is attributable to an underlying

trend towards milder disease or to improved therapy. METHODS: The study used

an inception cohort of early RA patients seen at the Wichita Arthritis

Center since 1973 and monitored prospectively since their first clinic visit

through clinical, radiographic, laboratory, demographic and self-reported

data. We compared the radiographic disease progression in patients that

started their disease in the 70's, the 80's and the 90's using a

multivariate regression model for longitudinal data. The analysis was

adjusted for differences in baseline predictors, type of DMARDs and steroids

use. RESULTS: 418 RA patients with radiographic follow- up were included.

Patients in earlier decades used fewer DMARDs, had longer disease durations

and higher tender joint counts at first visit. Other important predictors of

disease progression did not differ significantly between decades of disease

onset. The unadjusted rates of radiographic progression differed between

decades (ANOVA, p = 0.01), with a significant trend towards less

radiographic progression in more recent times (Trend, p < 0.001). However,

after adjusting for DMARD use, steroid use and baseline predictors,

differences between decades vanished (ANOVA, p = 0.40) and the trend towards

less radiographic progression disappeared (Trend, p = 0.45).

CONCLUSIONS: These results suggest that the observed trend to milder disease

in RA is attributable to more effective antirheumatic therapy and not to a

secular trend.

PMID: 16540549

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=PubMed & list_uids=1\

6540549 & dopt=Abstract

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