title: Patients with rheumatoid arthritis have better functional and working ability but poorer general health and higher comorbidity rates today than in the late 1990s.
abstract: OBJECTIVE
  Better treatment strategies and therapeutic options have changed the treatment of rheumatoid arthritis (RA) during the past decade. Our objective was to examine clinical and patient-reported outcomes in patients with RA treated in 1998-99 and 2011-12.
  
  
  METHODS
  The cross-sectional observational study included 303 consecutive outpatients (n = 103 in 1998-99 and n = 200 in 2011-12) from the same outpatient clinic. Patient questionnaires included patients' sociodemographics, the Health Assessment Questionnaire (HAQ) for functional ability, the Nottingham Health Profile (NHP) for health-related quality of life (HRQoL), self-reported general health (GH), and operations performed due to RA. A clinical examination was conducted for all patients. Comorbidities according to the Charlson Comorbidity Index (CCI), anti-rheumatic drugs and medications were recorded and the HAQ and NHP dimensions calculated. The results from these two patient cohorts were compared.
  
  
  RESULTS
  The cohorts were comparable with regard to age, sex, and RA duration while the patients in the 2011-12 cohort were less often seropositive for rheumatoid factor (RF), had a better socioeconomic situation, better functional and working ability, and a decreased rate of RA surgery. The patients in 2011-12 had higher comorbidities and poorer GH while the HRQoL dimensions did not differ between the cohorts except for better mobility in 2011-12. Methotrexate (MTX) and combinations of conventional anti-rheumatic drugs were more frequently used in 2011-12. Biologicals were used only in 2011-12.
  
  
  CONCLUSIONS
  According to our results, more active anti-rheumatic therapy coincides with better RA-related outcomes. However, the result was the opposite with regard to overall health and comorbidities. Is this a new challenge in the treatment RA?
authors.affiliation: Department of Medicine, Central Hospital of Lapland , Rovaniemi , Finland.
authors.forename: T
authors.initials: T
authors.lastname: Uutela
authors.forename: H
authors.initials: H
authors.lastname: Kautiainen
authors.forename: S
authors.initials: S
authors.lastname: Järvenpää
authors.forename: S
authors.initials: S
authors.lastname: Salomaa
authors.forename: M
authors.initials: M
authors.lastname: Hakala
authors.forename: A
authors.initials: A
authors.lastname: Häkkinen
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; 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*; D015331:Cohort Studies; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000188:drug therapy / Q000453:epidemiology; D004651:Employment / Q000639:trends*; D005260:Female; D005387:Finland / Q000453:epidemiology; D006304:Health Status; D006801:Humans; D006886:Hydroxychloroquine / Q000627:therapeutic use; D006949:Hyperlipidemias / Q000188:drug therapy / Q000453:epidemiology; D006973:Hypertension / Q000188:drug therapy / Q000453:epidemiology; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology; D063868:Patient Outcome Assessment; D012140:Respiratory Tract Diseases / Q000453:epidemiology; D012460:Sulfasalazine / Q000627:therapeutic use; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors
chemical_list: D000305:Adrenal Cortex Hormones; D018501:Antirheumatic Agents; D001688:Biological Products; D014409:Tumor Necrosis Factor-alpha; D012460:Sulfasalazine; D006886:Hydroxychloroquine; D008727:Methotrexate