NEW YORK (Reuters Health) – Disease activity at 10 years has improved for patients with inflammatory polyarthritis (IP), but disability and mortality are unchanged, according to a study that compared a cohort from the 1990s with one from the 2000s.
“It was surprising to see that patients with more recent symptom onset did not have improved disability over a 10-year period, despite reductions in disease activity,” said Dr. Suzanne Verstappen of the University of Manchester in the U.K. “Our hypothesis was that disability and disease activity would be lower in patients with more recent symptom onset, due to the important changes in the treatment and management of rheumatoid arthritis from the mid-nineties to the early 2000s.”
“This study illustrates a disconnect between disease activity and disability,” she told Reuters Health by email. “This indicates that more emphasis should be put on reducing disability, alongside aiming to reduce disease activity.”
Dr. Verstappen and her colleagues compared 10-year outcomes between two groups of IP patients in the Norfolk Arthritis Register who had been recruited 10 years apart.
Patients in the study were over 15 and had two or more swollen joints lasting four or more weeks. Cohort 1 consisted of patients recruited from 1990 to 1994, cohort 2 of those recruited from 2000 to 2004. Patients whose baseline assessment took place more than two years after symptom onset and those who were later diagnosed with a condition other than psoriatic arthritis, rheumatoid arthritis, postviral arthritis, or undifferentiated arthritis, were excluded.
As reported online February 23 in Annals of the Rheumatic Diseases, the authors collected demographic and clinical data at baseline and at years 1, 2, 3, 5, 7 and 10. They compared the cohorts according to longitudinal disease activity (swollen/tender joint counts in 51 joints (SJC51/TJC51)); disability, using the Health Assessment Questionnaire (HAQ); cardiovascular disease (CVD) risk; and 10-year mortality risk.
Over 10 years, the 631 patients in cohort 2 had 17% lower SJC51 than the 1,022 patients in cohort 1, while TJC51 and HAQ were similar in both groups.
Cohort 2 had significantly lower risks of all-cause mortality (hazard ratio, 0.72) and CVD mortality (subhazard ratio, 0.58) than cohort 1. But the differences were no longer significant after adjusting for changes in mortality risk in the general population over time.
Dr. Brian D. Golden, a rheumatologist at NYU Langone Health in New York City, told Reuters Health by phone, “It would be interesting to have this observational study conducted again comparing the original cohort with a more recent cohort another ten years later. I would expect that by comparing the original cohort with a cohort from the current era, we would be able to show that we are doing demonstrably better.”
“I think this study suffered from bad timing,” said Dr. Golden. “I think the authors analyzed two periods where the second period wasn’t recent enough. For example, if the more recent cohort would include patients from 2018, the percentage of patients on biologic DMARDs (disease-modifying antirheumatic drugs) would be much higher. The concept of treating patients sooner and more aggressively, including methotrexate and adding biologics early in the disease, is more in vogue now than it was during the time of the study’s second cohort.”
“It’s not a failure on the researchers’ part,” he added. “The time window did not work in their favor.”
SOURCE: https://bit.ly/2FXsyYJ
Ann Rheum Dis 2018.
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