Early Control of RA Predicted Less Disability

Rheumatoid arthritis patients who reached low disease activity earlier had less disability two years later

/ Author:  / Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh

(RxWiki News) Rheumatoid arthritis (RA) cannot be cured, but treatment can significantly reduce the signs and symptoms of the disease, and bring disease activity to a low level. Treating the disease as early as possible may make this goal easier.

A recent study found that RA patients who had achieved low disease activity after six months of treatment had a reduced likelihood of joint damage and disability two years out.

RA is a condition that primarily affects the joints. First-line treatment is generally an antirheumatic medication, which has been shown to effectively reduce RA-related inflammation.

"See a doctor if you're experiencing joint pain."

This study was conducted by Vivian Bykerk, MD, a rheumatologist at the Hospital for Special Surgery and colleagues.

The researchers used data from the Canadian Early Arthritis Cohort (CATCH). Dr. Bykerk is chair and director of CATCH, an ongoing multicenter research project in Canada that has been collecting information on patients with early inflammatory arthritis at 19 teaching and community-based hospitals, as well as clinics across Canada. So far, the project has collected information on 1,800 patients.

For this study, Dr. Bykerk and her team used the database to identify 833 patients with early RA who had been followed for two years. Early RA was defined as having had symptoms for one year or less.

A total of 75 percent of the patients were female and the average age was 53.

More than 90 percent of the patients took disease-modifying antirheumatic drugs (DMARDs). Methotrexate was used by 74 percent of the patients, steroids were used by 52 percent and biologics were used by 3 percent.

The researchers looked at the level of disability in patients two years after diagnosis and compared it to how it was affected by achieving low disease activity at six months.

Low disease activity means that joint pain, swelling and other inflammation markers were reduced.

The researchers compared patients using the health assessment questionnaire (HAQ) disability index. HAQ is a self-reported survey that gauges the difficulty an RA patient has performing basic activities, including walking, bathing, eating and dressing.

The researchers found that 56 percent of patients reached low disease activity at six months. These patients who got their condition under control sooner had better function than those who did not.

"Unfortunately, I have seen too many people delay effective treatment approaches and they come back a year later very disappointed, often with joint damage that could have been prevented. The longer you have inflammation in the joints, the more likely you are to have joint damage, and it is going to impact how you function down the road," Dr. Bykerk said in a press statement.

"We believe there is a window in which people have a much better chance of getting RA under good control, often with less intense therapy, and the window is within the first three months of developing joint inflammation," Dr. Bykerk said.

Patient age and sex also predicted disability (women generally have RA worse than me), and patients with fibromyalgia, a chronic pain condition, also had more disability.

This study will be presented at the annual meeting of the American College of Rheumatology/Association of Rheumatology Health Professionals on October 28 in San Diego.

The researchers did not disclose any financial ties.

Review Date: 
October 24, 2013
Last Updated:
October 27, 2013