title: Major trends in the manifestations and treatment of rheumatoid arthritis in a multiethnic cohort in Singapore.
abstract: We analyzed the epidemiological changes of rheumatoid arthritis (RA) over three decades using patients from a single center in Singapore. All patients who fulfill the 1987 American College of Rheumatology criteria for RA were invited to enroll in a prospective disease registry. We analyzed the patient demographics, disease manifestation, management and patient-reported outcomes, including quality of life (QoL), in the three categories according to the year of disease onset: before 1989 (group I), 1990-1999 (group II) and after 2000 (group III). There were 1,153 patients with 231, 532 and 390 in groups I, II and III, respectively. The mean disease durations were 25, 12 and 4.8 years, respectively. The majority was female (84.1 %) and Chinese (76.6 %) with no socio-demographic differences across the three periods. The age of onset rises and the prevalence of rheumatoid factor falls with the proximity of disease onset. Patients with most recent disease onset had the earliest access to the rheumatologist. They also had the highest tender and swollen joint counts, lowest deformed joint count and highest remission rate. Patients in group I report better mental and emotional QoL though many developed marked disability. We have documented changes of the manifestations of RA that are dependent and independent of improved treatment. Significant differences in accessibility to the rheumatologist, RA activity, functional capacity, quality of life and comorbidities were seen in subsequent cohorts due to treatment evolution and more efficient healthcare delivery.
authors.affiliation: Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore, Singapore.
authors.forename: Ee Tzun
authors.initials: ET
authors.lastname: Koh
authors.forename: Justina Wei Lynn
authors.initials: JW
authors.lastname: Tan
authors.forename: Bernard Yu-Hor
authors.initials: BY
authors.lastname: Thong
authors.forename: Cheng Lay
authors.initials: CL
authors.lastname: Teh
authors.forename: Tsui Yee
authors.initials: TY
authors.lastname: Lian
authors.forename: Weng Giap
authors.initials: WG
authors.lastname: Law
authors.forename: Arul
authors.initials: A
authors.lastname: Earnest
authors.forename: Kok Ooi
authors.initials: KO
authors.lastname: Kong
authors.forename: Tang Ching
authors.initials: TC
authors.lastname: Lau
authors.forename: Yew Kuang
authors.initials: YK
authors.lastname: Cheng
authors.forename: Hwee Siew
authors.initials: HS
authors.lastname: Howe
authors.forename: Wern Hui
authors.initials: WH
authors.lastname: Yong
authors.forename: Faith Li-Ann
authors.initials: FL
authors.lastname: Chia
authors.forename: Hiok Hee
authors.initials: HH
authors.lastname: Chng
authors.forename: Khai Pang
authors.initials: KP
authors.lastname: Leong
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000175:diagnosis / Q000188:drug therapy* / Q000208:ethnology* / Q000503:physiopathology / Q000523:psychology; D016009:Chi-Square Distribution; D003695:Delivery of Health Care / Q000639:trends*; D004185:Disability Evaluation; D004644:Emotions; D005260:Female; D006801:Humans; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011788:Quality of Life; D012042:Registries; D012074:Remission Induction; D012219:Rheumatology / Q000639:trends*; D012846:Singapore / Q000453:epidemiology; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D018501:Antirheumatic Agents