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

Abstract

ObjectiveTo compare the 10-year outcome (disease activity, disability, mortality) of two cohorts of patients with inflammatory polyarthritis (IP) recruited 10 years apart.MethodsPatients 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.ResultsIn 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).ConclusionDisease activity significantly improved in the new millennium, whereas disability and mortality were unchanged.

Trends in Prevalence of Functional Disability in Rheumatoid Arthritis Compared With the General Population

“…Two large cohort studies from Europe recently reported lack of improvement in physical functioning based on HAQ score in patients with inflammatory arthritis in the new millennium versus those diagnosed in previous decades [6][7] . While higher disease activity and delayed RA diagnosis has been linked to increased likelihood of disability [8][9] , the persistent FD excess appears to be despite the improvements in RA disease activity and RA management [6][7]10 .…”

“…Two large cohort studies from Europe recently reported lack of improvement in physical functioning based on HAQ score in patients with inflammatory arthritis in the new millennium versus those diagnosed in previous decades [6][7] . While higher disease activity and delayed RA diagnosis has been linked to increased likelihood of disability [8][9] , the persistent FD excess appears to be despite the improvements in RA disease activity and RA management [6][7]10 . The growing burden of mental and somatic comorbidity and pain, use of glucocorticoids and antidepressants, and increasing expectations for optimal physical functioning are possible reasons for the lack of improvement in FD in RA [6][7][11][12][13] .…”

Representativeness of a digitally engaged population and a patient organisation population with rheumatoid arthritis and their willingness to participate in research: a cross-sectional study

“…Although there was no CPRD comparison, the proportion who had ever taken biologics was high in both HU and NRAS compared with the reported UK estimates of 11%–16%. 15 16 This may indicate that both NRAS and HU respondents have more severe disease requiring biologics, and this may be why they are using HU or NRAS. However as we do not have disease activity measures, we cannot be sure of this.…”

Early Undifferentiated Arthritis: A Developing Country Perspective from Nepal

“…A study of Norfolk registry comparing outcomes of patients enrolled at a difference of 10years showed improvement in swollen joints in the later cohort with no significant difference in tender joint, mortality and functional disability. 61 However, even the later cohort was enrolled between 2000 and 2004 when the newer diagnostic modalities were not available and early DMARDs were not a norm. Outcomes of later cohort after 2010 is expected to give different results.…”