Have disease-modifying antirheumatic drugs and newer treatment strategies improved the long-term disability outlook for patients with rheumatoid arthritis? Scientists supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases say "yes."
Eswar Krishnan, M.D., M.Phil., and James Fries, M.D., of Stanford University School of Medicine, found that average disability levels in patients with rheumatoid arthritis have declined by 40 percent since 1977 at a rate of about 2 percent a year.
During the past 20 years, significant changes in managing rheumatoid arthritis have taken place. New and more powerful drugs are standard, and treatment with these new drugs is more aggressive. These treatment strategies have improved short-term disability outcomes, but long-term trends in disability had not been studied until now.
The scientists used data from 3,035 patients enrolled from 1977 to 1998 in the ARAMIS (Arthritis, Rheumatism, and Aging Medical Information System) data bank. The data bank is large, with treatment history for a broad range of patients, and contains measurements of disability that are widely accepted, including the ability to perform such daily activities as dressing, eating and walking. The study's timeframe corresponds to the period during which the use of the drug methotrexate became a standard treatment for rheumatoid arthritis. Since 1999, newer drugs such as etanercept, infliximab and leflunomide have been introduced and offer hope of even further reductions in disability.
Rheumatoid arthritis is a chronic autoimmune disease that can affect the entire body and causes pain, stiffness and swelling of the joints. It can produce serious destruction of one or more joints. While the exact cause is not known, research is revealing more information about the factors that cause inflammation.
The NIAMS is part of the U.S. Department of Health and Human Services' National Institutes of Health, the leading Federal agency in biomedical and behavioral research.
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Krishnan E, Fries J. Reduction in long-term functional disability in rheumatoid arthritis from 1977 to 1998: A longitudinal study of 3,035 patients. The American Journal of Medicine, 2003;115(5):371-376.