title: Time trends in disease activity, response and remission rates in rheumatoid arthritis during the past decade: results from the NOR-DMARD study 2000-2010.
abstract: OBJECTIVE
  To investigate whether baseline disease activity levels and responses in patients with rheumatoid arthritis (RA) changed during the period 2000-2010.
  
  
  METHODS
  Data were provided by the Norwegian disease-modifying antirheumatic drug (NOR-DMARD) study. Patients with inflammatory joint diseases starting new treatment with disease-modifying antirheumatic drugs (DMARDs) were consecutively included and followed longitudinally. Time trend analyses were performed in methotrexate (MTX)-naïve RA patients starting MTX monotherapy (MTX mono) and biologic DMARD (bDMARD)-naïve RA patients starting tumour necrosis factor inhibitors+MTX (TNFi+MTX).
  
  
  RESULTS
  A total of 2573 patients were included in the analyses: MTX mono n=1866 (69.9% female, 62.0% RF+, mean (SD) age 56.0 (13.7) years, median (25-75 percentile) time from diagnosis 0.2 (0.01-2.8) years); TNFi+MTX n=707 (70.3% female, 75.0% RF+, mean (SD) age 52.1 (13.2) years, median (25-75 percentile) time from diagnosis 5.7 (2.0-13.7) years). Significant time trends towards lower baseline disease activity score 28 (DAS28) as well as other disease activity measures were found in both groups (DAS28 from 5.17 to 4.75 in MTX mono and from 5.88 to 4.64 in TNFi+MTX), and disease duration became shorter. Six-month DAS28 remission rates increased significantly over the years (from 17.8 to 37.6 in MTX mono and from 16.9 to 46.3 in TNFi+MTX).
  
  
  CONCLUSIONS
  During the last decade, baseline RA disease activity level at the time of starting MTX as well as TNFi+MTX decreased from high to moderate. A more than twofold increase in 6-month remission rates was observed in both groups. Our findings indicate that clinicians have implemented modern, more aggressive treatment strategies, which hopefully will lead to better long-term disease outcomes.
authors.affiliation: Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.
authors.forename: Anna-Birgitte
authors.initials: AB
authors.lastname: Aga
authors.affiliation: Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Lie
authors.affiliation: Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.
authors.forename: Till
authors.initials: T
authors.lastname: Uhlig
authors.affiliation: Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.
authors.forename: Inge Christoffer
authors.initials: IC
authors.lastname: Olsen
authors.affiliation: Department of Rheumatology, Vestre Viken/Drammen Hospital, Drammen, Norway.
authors.forename: Ada
authors.initials: A
authors.lastname: Wierød
authors.affiliation: Department of Rheumatology, University Hospital of Northern Norway, Tromsø, Norway.
authors.forename: Synøve
authors.initials: S
authors.lastname: Kalstad
authors.affiliation: Department of Rheumatology, St. Olavs Hospital, Trondheim, Norway.
authors.forename: Erik
authors.initials: E
authors.lastname: Rødevand
authors.affiliation: Lillehammer Hospital for Rheumatic Diseases, Lillehammer, Norway.
authors.forename: Knut
authors.initials: K
authors.lastname: Mikkelsen
authors.affiliation: Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.
authors.forename: Tore K
authors.initials: TK
authors.lastname: Kvien
authors.affiliation: Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.
authors.forename: Espen A
authors.initials: EA
authors.lastname: Haavardsholm
mesh_terms: D018501:Antirheumatic Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012074:Remission Induction; D013995:Time
chemical_list: D018501:Antirheumatic Agents
keywords: Methotrexate; Rheumatoid Arthritis; TNF-alpha