Maria D Mjaavatten1, Helga Radner2, Kazuki Yoshida3, Nancy A Shadick4, Michelle L Frits4, Christine K Iannaccone4, Tore K Kvien5, Michael E Weinblatt4, Daniel H Solomon6. 1. Division of Rheumatology, Immunology and Allergy, Brigham and Women׳s Hospital, Boston, MA; Department of Rheumatology, Diakonhjemmet Hospital, P.O. Box 23 Vinderen 0319, Oslo, Norway. Electronic address: maria_mjaavatten@hotmail.com. 2. Division of Rheumatology, Immunology and Allergy, Brigham and Women׳s Hospital, Boston, MA; Department of Internal Medicine III, Medical University Vienna, Vienna, Austria. 3. Division of Rheumatology, Immunology and Allergy, Brigham and Women׳s Hospital, Boston, MA; Department of Rheumatology, Kameda Medical Center, Kamogawa, Chiba Prefecture, Japan. 4. Division of Rheumatology, Immunology and Allergy, Brigham and Women׳s Hospital, Boston, MA. 5. Department of Rheumatology, Diakonhjemmet Hospital, P.O. Box 23 Vinderen 0319, Oslo, Norway. 6. Division of Rheumatology, Immunology and Allergy, Brigham and Women׳s Hospital, Boston, MA; Division of Pharmacoepidemiology, Brigham and Women׳s Hospital, Boston, MA.
Abstract
OBJECTIVE: Current recommendations advocate treatment with disease-modifying anti-rheumatic drugs (DMARDs) in all patients with active rheumatoid arthritis (RA). We analyzed short-term disease outcome in patients according to the consistency of DMARD use in a clinical rheumatology cohort. METHODS: Patients in an RA registry (n = 617) were studied for DMARD use at semi-annual study time points during the first 18 months of follow-up and were divided into 4 groups according to the number of study time points with any DMARD use [0-1 study time points (n = 31), 2 study time points (n = 24), 3 study time points (n = 77), and 4 study time points (n = 485)]. The primary outcome analyses were performed at 24 months and included Disease Activity Score 28 (DAS28-CRP), modified Health Assessment Questionnaire (MHAQ) change, Short Form Health Survey-12 physical and mental summary scores (SF-12 PCS, SF-12 MCS), EuroQol 5-Dimensional health index (EQ-5D), and radiographic progression. Unadjusted, adjusted, and analyses stratified for seropositivity and disease activity were performed. A secondary analysis investigated 36-month outcomes. RESULTS: No significant 24-month outcome differences could be found between the DMARD use categories. For seropositive patients, there was evidence of a linear trend for SF-12 PCS (p = 0.02) and EQ-5D (p = 0.01) with worse outcomes for inconsistent DMARD users. At 36 months, there was a linear trend for higher DAS28-CRP scores for inconsistent users (p < 0.01). CONCLUSIONS: Overall, we found poor correlation between inconsistent DMARD use and short-term disease outcome. However, outcome in the longer term could be negatively influenced by inconsistent DMARD use, as well as short-term outcome in seropositive patients.
OBJECTIVE: Current recommendations advocate treatment with disease-modifying anti-rheumatic drugs (DMARDs) in all patients with active rheumatoid arthritis (RA). We analyzed short-term disease outcome in patients according to the consistency of DMARD use in a clinical rheumatology cohort. METHODS:Patients in an RA registry (n = 617) were studied for DMARD use at semi-annual study time points during the first 18 months of follow-up and were divided into 4 groups according to the number of study time points with any DMARD use [0-1 study time points (n = 31), 2 study time points (n = 24), 3 study time points (n = 77), and 4 study time points (n = 485)]. The primary outcome analyses were performed at 24 months and included Disease Activity Score 28 (DAS28-CRP), modified Health Assessment Questionnaire (MHAQ) change, Short Form Health Survey-12 physical and mental summary scores (SF-12 PCS, SF-12 MCS), EuroQol 5-Dimensional health index (EQ-5D), and radiographic progression. Unadjusted, adjusted, and analyses stratified for seropositivity and disease activity were performed. A secondary analysis investigated 36-month outcomes. RESULTS: No significant 24-month outcome differences could be found between the DMARD use categories. For seropositive patients, there was evidence of a linear trend for SF-12 PCS (p = 0.02) and EQ-5D (p = 0.01) with worse outcomes for inconsistent DMARD users. At 36 months, there was a linear trend for higher DAS28-CRP scores for inconsistent users (p < 0.01). CONCLUSIONS: Overall, we found poor correlation between inconsistent DMARD use and short-term disease outcome. However, outcome in the longer term could be negatively influenced by inconsistent DMARD use, as well as short-term outcome in seropositive patients.
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