Functional improvement after patients with rheumatoid arthritis start a new disease modifying antirheumatic drug (DMARD) associated with frequent changes in DMARD: the CORRONA database.
OBJECTIVE
We examined the relationships of rheumatoid arthritis (RA), disease duration (DD), number of previous disease modifying antirheumatic drugs (DMARD), and frequency of DMARD changes, with regard to changes in function in patients with RA evaluated by modified Health Assessment Questionnaire (mHAQ) after the start of a new DMARD.


METHODS
In total, 889 patients with active RA from the CORRONA database [patients had mHAQ>or=0.5 and/or Disease Activity Score 28-joint count (DAS28)>or=1.6] started a new DMARD (baseline) and had at least one followup visit 6-12 mo later. Change in mHAQ from baseline to followup visit was modeled using univariate/multivariate linear regression analysis. Due to colinearity, separate multivariate regression models were performed including/excluding the predictors disease duration, number of prior DMARD, and frequency of DMARD changes.


RESULTS
Baseline age, mHAQ, erythrocyte sedimentation rate (ESR), DAS28, and number of prior DMARD differed across DD groups. The univariate linear regression model showed that higher baseline values of mHAQ, DAS28, swollen joint count (SJC), tender joint count (TJC), Clinical Disease Activity Index (CDAI), ESR, physician global assessment, prednisone use, and subsequent addition/discontinuation of DMARD were associated with improvement of the mHAQ at followup (p=0.05). Multivariate linear regression models showed that mHAQ improvement was associated with shorter DD, higher baseline mHAQ, addition of subsequent DMARD, and the DMARD frequency index (no. previous DMARD/yrs of DD) (p<0.05). Number of DMARD patients used previously was not associated with change of mHAQ in either model.


CONCLUSIONS
Our study demonstrates that in clinical rheumatologic practices, more frequent changes in DMARD are associated with greater improvement in function (by mHAQ). It does not support the idea that number of previous DMARD used predicts response. Indirectly, these data support the concept that DMARD should be changed if optimal responses are not achieved within a specified time.
Ranganath
Veena K
VK
Department of Medicine, Division of Rheumatology, UCLA Rehabilitation Center, University of California, Los Angeles, California 90095-1670, USA. vranganath@mednet.ucla.ed
Paulus
Harold E
HE
Onofrei
Alina
A
Khanna
Dinesh
D
Reed
George
G
Elashoff
David A
DA
Kremer
Joel M
JM
Furst
Daniel E
DE
D000328:Adult; D000368:Aged; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D012042:Registries; D012720:Severity of Illness Index; D017211:Treatment Failure
D018501:Antirheumatic Agents
Arthritis Rheum. 1999 Sep;42(9):1854-60
10513799
Arthritis Res Ther. 2006;8(2):R46
16507172
J Rheumatol. 2004 Aug;31(8):1532-7
15290731
Rheumatology (Oxford). 2002 Dec;41(12):1367-74
12468815
Arthritis Rheum. 1983 Nov;26(11):1346-53
6639693
Lancet. 2004 Jul 17-23;364(9430):263-9
15262104
J Rheumatol. 1990 Oct;17(10):1268-73
1979349
J Rheumatol. 2001 May;28(5):982-9
11361226
Arthritis Rheum. 2000 Jan;43(1):22-9
10643696
Arthritis Rheum. 2005 Nov;52(11):3381-90
16258899
J Rheumatol. 1997 May;24(5):838-44
9150069
J Rheumatol. 1993 Mar;20(3):557-60
8478873
Ann Rheum Dis. 1993 Jun;52(6):423-8
8100702
Ann Rheum Dis. 2006 Feb;65(2):227-33
15975967
J Rheumatol. 2005 Apr;32(4):590-601
15801012
J Rheumatol. 2002 Aug;29(8):1639-45
12180722