RESEARCH - Trends toward an improved disease state in RA over time: influence of new therapies and changes in management approach: EMECAR

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Arthritis Research & Therapy 2008, 10:R138doi:10.1186/ar2561

Trends towards an improved disease state in rheumatoid arthritis over

time: influence of new therapies and changes in management approach:

analysis of the EMECAR cohort

Isidoro González-Alvaro1 , Angel Descalzo2 and Loreto Carmona2

for the EMECAR Study Group

1Rheumatology Service, Hospital Universitario de la Princesa, c/Diego

de León 62, Madrid 28006, Spain

2Research Unit, Fundación Española de Reumatología, c/Marques del

Duero 5, 1°, Madrid 28001, Spain

Abstract

Introduction

The disease activity in patients with rheumatoid arthritis has

improved during the past decade. The availability of new drugs and

also a better assessment of the disease have been proposed to be

responsible for this improvement. In the present work we estimate the

effect of these factors on disease activity and function in patients

with rheumatoid arthritis at the beginning of the new century.

Methods

The Estudio de la Morbilidad y Expresión Clínica de la Artritis

Reumatoide (EMECAR) cohort was assembled in 2000 from the random

sampling of rheumatoid arthritis patients registered in 34 centers.

The cohort was composed of 789 patients who underwent a baseline

assessment plus four annual follow-up visits in which functional

ability (Health Assessment Questionnaire score), the disease activity

score obtained from 28-joint count with three parameters (DAS28-3) and

radiological progression (Larsen score) were recorded. The effect of

the calendar year on the DAS28-3, the Health Assessment Questionnaire

score, and the Larsen score was obtained from adjusted models in which

all treatments were included as dummy variables.

Results

The effect of time as the β coefficient (95% confidence interval) for

2004, taking 2000 as a reference year, was -0.43 (-0.58 to -0.28) for

the DAS28-3, 0.15 (0.07 to 0.22) for the Health Assessment

Questionnaire score, and 4.4 (2.68 to 6.12) for the Larsen score.

Treatment with new therapies, either leflunomide or TNF antagonists,

increased in frequency from 1.1% (n = 8) in 2000 to 30.9% (n = 144) in

2004. Treatment with TNF antagonists (-0.28 (-0.5 to -0.05)) and with

gold salts (-0.21 (-0.38 to -0.04)) was independently associated with

a decrease in the DAS28-3 over time, whereas cyclosporin A treatment

(0.45 (0.13 to 0.76)) was associated with an increase in disease

activity.

Conclusions

The mean disease activity of rheumatoid arthritis has improved from

2000 to 2004. An explanation is the introduction of new therapies, but

not solely. Other factors related to the calendar year, plausibly a

better management of available drugs, show a greater effect on

improvement than the drugs used.

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http://arthritis-research.com/content/10/6/R138

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