title: Disability in rheumatoid arthritis in the era of biological treatments.
abstract: OBJECTIVE
  Rheumatoid arthritis (RA) is a disabling disease. The authors studied the impact of new, expensive and occasionally toxic biological treatments on disability outcomes in real-world populations of patients with RA.
  
  
  METHODS
  The authors analysed Health Assessment Questionnaire Disability Index data on 4651 adult patients with RA collected prospectively from 1983 to 2006. They studied trends in disability using multilevel mixed-effects multivariable linear regression (mixed) models that adjusted for the effects of time trends in gender, ethnicity, age, smoking behaviour and disease duration.
  
  
  RESULTS
  Overall, the patients were predominantly female (76%), were predominantly white (88%), had 13 years of education and have had RA for 13 years, on average. The time period from 1983 to 2006 saw major increases in the use of disease-modifying agents and biological agents, and a decrease in smoking. After adjustments, the disability rates declined at annual rates of 1.7% (1.5-1.8%) overall and 2.7% (2.4-3.1%) among men. The annual rate of disability declines in the biological era was greater than that in the preceding period, suggesting accelerated improvement. These declines were documented in all patient subgroups such as men, women, African-Americans, obese, older age groups and early disease (p<0.001), but not among the 1401 patients (where disability remained stable) who died on follow-up.
  
  
  CONCLUSIONS
  Aggressive use of traditional disease-modifying agents and introduction of biological agents were associated with substantial gains in disability outcomes. Our finding supports the prevailing notion that 'tight inflammation control' is a desirable therapeutic strategy.
authors.affiliation: Division of Rheumatology and Immunology, Stanford University Department of Medicine, Palo Alto, CA 94304, USA. arthritis.md@gmail.com
authors.forename: Eswar
authors.initials: E
authors.lastname: Krishnan
authors.forename: Bharathi
authors.initials: B
authors.lastname: Lingala
authors.forename: Bonnie
authors.initials: B
authors.lastname: Bruce
authors.forename: James F
authors.initials: JF
authors.lastname: Fries
mesh_terms: D000328:Adult; D000368:Aged; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology; D001688:Biological Products / Q000627:therapeutic use*; D015992:Body Mass Index; D004185:Disability Evaluation; D004363:Drug Utilization / Q000639:trends; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use; D008875:Middle Aged; D011446:Prospective Studies; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
chemical_list: D018501:Antirheumatic Agents; D001688:Biological Products; D007166:Immunosuppressive Agents; D008727:Methotrexate