D Kuettel1, J Primdahl1,2,3,4, R Christensen5, L M Ørnbjerg6, K Hørslev-Petersen1,7. 1. a King Christian X's Hospital for Rheumatic Diseases , Graasten , Denmark. 2. b Institute for Regional Health Research , University of Southern Denmark , Odense , Denmark. 3. c Hospital of Southern Jutland , Aabenraa , Denmark. 4. d Danbio Registry , Rigshospitalet Glostrup , Glostrup , Denmark. 5. e Musculoskeletal Statistics Unit, The Parker Institute , Bispebjerg and Frederiksberg Hospitals , Copenhagen , Denmark. 6. f Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases , Rigshospitalet Glostrup , Glostrup , Denmark. 7. g Faculty of Health Scienses , University of Southern Denmark , Odense , Denmark.
Abstract
OBJECTIVE: To investigate the impact of patient-reported flares on radiographic damage and disability in rheumatoid arthritis (RA). METHOD: Patients with low-active (Disease Activity Score based on 28-joint count with C-reactive protein < 3.2) RA were followed for 2 years. Based on annual questionnaires about incidence of flares, three 'flare phenotypes' were distinguished: no flares (NF), transient flares (TF), and a mixed category reporting persistent joint complaints (PJC) in at least one year. Baseline and 2 year radiographs of hands and feet were evaluated according to the Sharp/van der Heijde method. Major outcomes were change from baseline in Total Sharp Score (ΔTSS) and functional impairment, expressed by the Health Assessment Questionnaire (ΔHAQ). Their association with flare phenotype was analysed by logistic regression. RESULTS: The study included 268 RA patients (70% female; 73% immunoglobulin M rheumatoid factor positive), with a median age (interquartile range) of 63 (55-70) years, and 7 (4-13) years' disease duration. Flares were recalled as NF (n = 77), TF (n = 141), and PJC (n = 50). ΔTSS > 0 was observed in 35%, 37%, and 46%, respectively (p = 0.42), but statistically significantly (p = 0.01) more patients progressed in the TF (10%) and PJC (14%) compared to NF (0%), based on the smallest detectable change (> 4.4 ΔTSS unit). ΔHAQ above the minimal clinically important difference (> 0.22) was seen in 13% (NF), 21% (TF), and 40% (PJC) (p = 0.0015), with PJC being associated with statistically significant impairment in function (odds ratio 4.47, 95% confidence interval 1.87-10.69) compared to NF. CONCLUSION: In RA patients with low disease activity, the incidence of radiographic progression and functional impairment was higher in patients with flares and persistent complaints, compared to those without flares.
OBJECTIVE: To investigate the impact of patient-reported flares on radiographic damage and disability in rheumatoid arthritis (RA). METHOD:Patients with low-active (Disease Activity Score based on 28-joint count with C-reactive protein < 3.2) RA were followed for 2 years. Based on annual questionnaires about incidence of flares, three 'flare phenotypes' were distinguished: no flares (NF), transient flares (TF), and a mixed category reporting persistent joint complaints (PJC) in at least one year. Baseline and 2 year radiographs of hands and feet were evaluated according to the Sharp/van der Heijde method. Major outcomes were change from baseline in Total Sharp Score (ΔTSS) and functional impairment, expressed by the Health Assessment Questionnaire (ΔHAQ). Their association with flare phenotype was analysed by logistic regression. RESULTS: The study included 268 RApatients (70% female; 73% immunoglobulin M rheumatoid factor positive), with a median age (interquartile range) of 63 (55-70) years, and 7 (4-13) years' disease duration. Flares were recalled as NF (n = 77), TF (n = 141), and PJC (n = 50). ΔTSS > 0 was observed in 35%, 37%, and 46%, respectively (p = 0.42), but statistically significantly (p = 0.01) more patients progressed in the TF (10%) and PJC (14%) compared to NF (0%), based on the smallest detectable change (> 4.4 ΔTSS unit). ΔHAQ above the minimal clinically important difference (> 0.22) was seen in 13% (NF), 21% (TF), and 40% (PJC) (p = 0.0015), with PJC being associated with statistically significant impairment in function (odds ratio 4.47, 95% confidence interval 1.87-10.69) compared to NF. CONCLUSION: In RApatients with low disease activity, the incidence of radiographic progression and functional impairment was higher in patients with flares and persistent complaints, compared to those without flares.
Authors: Signe Møller-Bisgaard; Kim Hørslev-Petersen; Bo Ejbjerg; Merete Lund Hetland; Lykke Midtbøll Ørnbjerg; Daniel Glinatsi; Jakob Møller; Mikael Boesen; Robin Christensen; Kristian Stengaard-Pedersen; Ole Rintek Madsen; Bente Jensen; Jan Alexander Villadsen; Ellen-Margrethe Hauge; Philip Bennett; Oliver Hendricks; Karsten Asmussen; Marcin Kowalski; Hanne Lindegaard; Sabrina Mai Nielsen; Henning Bliddal; Niels Steen Krogh; Torkell Ellingsen; Agnete H Nielsen; Lone Balding; Anne Grethe Jurik; Henrik S Thomsen; Mikkel Østergaard Journal: JAMA Date: 2019-02-05 Impact factor: 56.272
Authors: Daniel F McWilliams; Shimin Rahman; Richard J E James; Eamonn Ferguson; Patrick D W Kiely; Adam Young; David A Walsh Journal: BMC Rheumatol Date: 2019-11-18