title: Patients with Rheumatoid Arthritis in the Australian OPAL Cohort Show Significant Improvement in Disease Activity over 5 Years: A Multicenter Observational Study.
abstract: OBJECTIVE
  To evaluate disease activity trends in a large cohort of Australian patients with rheumatoid arthritis (RA) from 2009 to 2014.
  
  
  METHODS
  This is a multicenter, cross-sectional, noninterventional study of patients with RA treated in Australia. Patients with RA treated at participating OPAL (Optimising Patient outcome in Australian RheumatoLogy) clinics were included in the study. Data, deidentified by patient, clinic, and clinician, were identified using a purpose-written electronic medical record. Patient demographics, disease onset, medications, and disease measures were analyzed. The Disease Activity Score at 28 joints (DAS28) was used to classify patients into the disease activity states of remission: low disease activity, moderate disease activity (MDA), and high disease activity. Choice of therapy was at the discretion of the treating clinician.
  
  
  RESULTS
  At the time of analysis, the database contained 15,679 patients with RA, 8998 of whom fulfilled the inclusion criteria. Mean age was 63.2 years, mean disease duration was 13.8 years, and the majority were women (72.4%). A total of 37,274 individual DAS28-erythrocyte sedimentation rate scores were recorded for the 8998 patients. The frequency of remission increased significantly from 36.7% in 2009 to 53.5% in 2014 (p < 0.001), and that of MDA decreased from 33% (2009) to 22.2% (2014). The use of biologic disease-modifying antirheumatic drugs for the patients in remission increased from 17% in 2009 to 36.9% in 2014.
  
  
  CONCLUSIONS
  Contemporary management of RA in Australia shows improvements in disease activity toward the target of remission over a 5-year period.
authors.affiliation: From Monash University, Clayton; James Cook University, Douglas; Combined Rheumatology Practice, Sydney; Gold Coast Rheumatology, Southport; Barwon Rheumatology Service, Geelong; Coast Joint Care, Maroochydore; Roche Products Propriety Limited, Dee Why; Menzies Research Institute Tasmania, Hobart; Canberra Rheumatology, Canberra, Australia.G. Littlejohn, MD, MPH, MBBS, FRACP, Professor of Medicine, Monash University; L. Roberts, MBBS, PhD, FRACP, Associate Professor of Medicine, Monash University and James Cook University; P. Bird, BMed (Hons), FRACP, PhD, Grad Dip (MRI), Rheumatologist, Combined Rheumatology Practice; J. de Jager, MBBS, FRACP, Professor of Medicine, Gold Coast Rheumatology; H. Griffiths, MBBS, FRACP, Rheumatologist, Barwon Rheumatology Service; D. Nicholls, BHB, MBChB, FRACP, Rheumatologist, Coast Joint Care; J. Young, PhD, Medical Manager, Roche Products Propriety Limited; J. Zochling, MBBS, FRACP, MMed (ClinEpi), PhD, Rheumatologist, Menzies Research Institute Tasmania; K.E. Tymms, MBBS, FRACP, Associate Professor of Medicine, Canberra Rheumatology. geoff.littlejohn@monash.edu.
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Littlejohn
authors.affiliation: From Monash University, Clayton; James Cook University, Douglas; Combined Rheumatology Practice, Sydney; Gold Coast Rheumatology, Southport; Barwon Rheumatology Service, Geelong; Coast Joint Care, Maroochydore; Roche Products Propriety Limited, Dee Why; Menzies Research Institute Tasmania, Hobart; Canberra Rheumatology, Canberra, Australia.G. Littlejohn, MD, MPH, MBBS, FRACP, Professor of Medicine, Monash University; L. Roberts, MBBS, PhD, FRACP, Associate Professor of Medicine, Monash University and James Cook University; P. Bird, BMed (Hons), FRACP, PhD, Grad Dip (MRI), Rheumatologist, Combined Rheumatology Practice; J. de Jager, MBBS, FRACP, Professor of Medicine, Gold Coast Rheumatology; H. Griffiths, MBBS, FRACP, Rheumatologist, Barwon Rheumatology Service; D. Nicholls, BHB, MBChB, FRACP, Rheumatologist, Coast Joint Care; J. Young, PhD, Medical Manager, Roche Products Propriety Limited; J. Zochling, MBBS, FRACP, MMed (ClinEpi), PhD, Rheumatologist, Menzies Research Institute Tasmania; K.E. Tymms, MBBS, FRACP, Associate Professor of Medicine, Canberra Rheumatology.
authors.forename: Lynden
authors.initials: L
authors.lastname: Roberts
authors.affiliation: From Monash University, Clayton; James Cook University, Douglas; Combined Rheumatology Practice, Sydney; Gold Coast Rheumatology, Southport; Barwon Rheumatology Service, Geelong; Coast Joint Care, Maroochydore; Roche Products Propriety Limited, Dee Why; Menzies Research Institute Tasmania, Hobart; Canberra Rheumatology, Canberra, Australia.G. Littlejohn, MD, MPH, MBBS, FRACP, Professor of Medicine, Monash University; L. Roberts, MBBS, PhD, FRACP, Associate Professor of Medicine, Monash University and James Cook University; P. Bird, BMed (Hons), FRACP, PhD, Grad Dip (MRI), Rheumatologist, Combined Rheumatology Practice; J. de Jager, MBBS, FRACP, Professor of Medicine, Gold Coast Rheumatology; H. Griffiths, MBBS, FRACP, Rheumatologist, Barwon Rheumatology Service; D. Nicholls, BHB, MBChB, FRACP, Rheumatologist, Coast Joint Care; J. Young, PhD, Medical Manager, Roche Products Propriety Limited; J. Zochling, MBBS, FRACP, MMed (ClinEpi), PhD, Rheumatologist, Menzies Research Institute Tasmania; K.E. Tymms, MBBS, FRACP, Associate Professor of Medicine, Canberra Rheumatology.
authors.forename: Paul
authors.initials: P
authors.lastname: Bird
authors.affiliation: From Monash University, Clayton; James Cook University, Douglas; Combined Rheumatology Practice, Sydney; Gold Coast Rheumatology, Southport; Barwon Rheumatology Service, Geelong; Coast Joint Care, Maroochydore; Roche Products Propriety Limited, Dee Why; Menzies Research Institute Tasmania, Hobart; Canberra Rheumatology, Canberra, Australia.G. Littlejohn, MD, MPH, MBBS, FRACP, Professor of Medicine, Monash University; L. Roberts, MBBS, PhD, FRACP, Associate Professor of Medicine, Monash University and James Cook University; P. Bird, BMed (Hons), FRACP, PhD, Grad Dip (MRI), Rheumatologist, Combined Rheumatology Practice; J. de Jager, MBBS, FRACP, Professor of Medicine, Gold Coast Rheumatology; H. Griffiths, MBBS, FRACP, Rheumatologist, Barwon Rheumatology Service; D. Nicholls, BHB, MBChB, FRACP, Rheumatologist, Coast Joint Care; J. Young, PhD, Medical Manager, Roche Products Propriety Limited; J. Zochling, MBBS, FRACP, MMed (ClinEpi), PhD, Rheumatologist, Menzies Research Institute Tasmania; K.E. Tymms, MBBS, FRACP, Associate Professor of Medicine, Canberra Rheumatology.
authors.forename: Julien
authors.initials: J
authors.lastname: de Jager
authors.affiliation: From Monash University, Clayton; James Cook University, Douglas; Combined Rheumatology Practice, Sydney; Gold Coast Rheumatology, Southport; Barwon Rheumatology Service, Geelong; Coast Joint Care, Maroochydore; Roche Products Propriety Limited, Dee Why; Menzies Research Institute Tasmania, Hobart; Canberra Rheumatology, Canberra, Australia.G. Littlejohn, MD, MPH, MBBS, FRACP, Professor of Medicine, Monash University; L. Roberts, MBBS, PhD, FRACP, Associate Professor of Medicine, Monash University and James Cook University; P. Bird, BMed (Hons), FRACP, PhD, Grad Dip (MRI), Rheumatologist, Combined Rheumatology Practice; J. de Jager, MBBS, FRACP, Professor of Medicine, Gold Coast Rheumatology; H. Griffiths, MBBS, FRACP, Rheumatologist, Barwon Rheumatology Service; D. Nicholls, BHB, MBChB, FRACP, Rheumatologist, Coast Joint Care; J. Young, PhD, Medical Manager, Roche Products Propriety Limited; J. Zochling, MBBS, FRACP, MMed (ClinEpi), PhD, Rheumatologist, Menzies Research Institute Tasmania; K.E. Tymms, MBBS, FRACP, Associate Professor of Medicine, Canberra Rheumatology.
authors.forename: Hedley
authors.initials: H
authors.lastname: Griffiths
authors.affiliation: From Monash University, Clayton; James Cook University, Douglas; Combined Rheumatology Practice, Sydney; Gold Coast Rheumatology, Southport; Barwon Rheumatology Service, Geelong; Coast Joint Care, Maroochydore; Roche Products Propriety Limited, Dee Why; Menzies Research Institute Tasmania, Hobart; Canberra Rheumatology, Canberra, Australia.G. Littlejohn, MD, MPH, MBBS, FRACP, Professor of Medicine, Monash University; L. Roberts, MBBS, PhD, FRACP, Associate Professor of Medicine, Monash University and James Cook University; P. Bird, BMed (Hons), FRACP, PhD, Grad Dip (MRI), Rheumatologist, Combined Rheumatology Practice; J. de Jager, MBBS, FRACP, Professor of Medicine, Gold Coast Rheumatology; H. Griffiths, MBBS, FRACP, Rheumatologist, Barwon Rheumatology Service; D. Nicholls, BHB, MBChB, FRACP, Rheumatologist, Coast Joint Care; J. Young, PhD, Medical Manager, Roche Products Propriety Limited; J. Zochling, MBBS, FRACP, MMed (ClinEpi), PhD, Rheumatologist, Menzies Research Institute Tasmania; K.E. Tymms, MBBS, FRACP, Associate Professor of Medicine, Canberra Rheumatology.
authors.forename: Dave
authors.initials: D
authors.lastname: Nicholls
authors.affiliation: From Monash University, Clayton; James Cook University, Douglas; Combined Rheumatology Practice, Sydney; Gold Coast Rheumatology, Southport; Barwon Rheumatology Service, Geelong; Coast Joint Care, Maroochydore; Roche Products Propriety Limited, Dee Why; Menzies Research Institute Tasmania, Hobart; Canberra Rheumatology, Canberra, Australia.G. Littlejohn, MD, MPH, MBBS, FRACP, Professor of Medicine, Monash University; L. Roberts, MBBS, PhD, FRACP, Associate Professor of Medicine, Monash University and James Cook University; P. Bird, BMed (Hons), FRACP, PhD, Grad Dip (MRI), Rheumatologist, Combined Rheumatology Practice; J. de Jager, MBBS, FRACP, Professor of Medicine, Gold Coast Rheumatology; H. Griffiths, MBBS, FRACP, Rheumatologist, Barwon Rheumatology Service; D. Nicholls, BHB, MBChB, FRACP, Rheumatologist, Coast Joint Care; J. Young, PhD, Medical Manager, Roche Products Propriety Limited; J. Zochling, MBBS, FRACP, MMed (ClinEpi), PhD, Rheumatologist, Menzies Research Institute Tasmania; K.E. Tymms, MBBS, FRACP, Associate Professor of Medicine, Canberra Rheumatology.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Young
authors.affiliation: From Monash University, Clayton; James Cook University, Douglas; Combined Rheumatology Practice, Sydney; Gold Coast Rheumatology, Southport; Barwon Rheumatology Service, Geelong; Coast Joint Care, Maroochydore; Roche Products Propriety Limited, Dee Why; Menzies Research Institute Tasmania, Hobart; Canberra Rheumatology, Canberra, Australia.G. Littlejohn, MD, MPH, MBBS, FRACP, Professor of Medicine, Monash University; L. Roberts, MBBS, PhD, FRACP, Associate Professor of Medicine, Monash University and James Cook University; P. Bird, BMed (Hons), FRACP, PhD, Grad Dip (MRI), Rheumatologist, Combined Rheumatology Practice; J. de Jager, MBBS, FRACP, Professor of Medicine, Gold Coast Rheumatology; H. Griffiths, MBBS, FRACP, Rheumatologist, Barwon Rheumatology Service; D. Nicholls, BHB, MBChB, FRACP, Rheumatologist, Coast Joint Care; J. Young, PhD, Medical Manager, Roche Products Propriety Limited; J. Zochling, MBBS, FRACP, MMed (ClinEpi), PhD, Rheumatologist, Menzies Research Institute Tasmania; K.E. Tymms, MBBS, FRACP, Associate Professor of Medicine, Canberra Rheumatology.
authors.forename: Jane
authors.initials: J
authors.lastname: Zochling
authors.affiliation: From Monash University, Clayton; James Cook University, Douglas; Combined Rheumatology Practice, Sydney; Gold Coast Rheumatology, Southport; Barwon Rheumatology Service, Geelong; Coast Joint Care, Maroochydore; Roche Products Propriety Limited, Dee Why; Menzies Research Institute Tasmania, Hobart; Canberra Rheumatology, Canberra, Australia.G. Littlejohn, MD, MPH, MBBS, FRACP, Professor of Medicine, Monash University; L. Roberts, MBBS, PhD, FRACP, Associate Professor of Medicine, Monash University and James Cook University; P. Bird, BMed (Hons), FRACP, PhD, Grad Dip (MRI), Rheumatologist, Combined Rheumatology Practice; J. de Jager, MBBS, FRACP, Professor of Medicine, Gold Coast Rheumatology; H. Griffiths, MBBS, FRACP, Rheumatologist, Barwon Rheumatology Service; D. Nicholls, BHB, MBChB, FRACP, Rheumatologist, Coast Joint Care; J. Young, PhD, Medical Manager, Roche Products Propriety Limited; J. Zochling, MBBS, FRACP, MMed (ClinEpi), PhD, Rheumatologist, Menzies Research Institute Tasmania; K.E. Tymms, MBBS, FRACP, Associate Professor of Medicine, Canberra Rheumatology.
authors.forename: Kathleen E
authors.initials: KE
authors.lastname: Tymms
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000473:pathology*; D001315:Australia; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012074:Remission Induction; D012720:Severity of Illness Index; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D018501:Antirheumatic Agents
keywords: DISEASE ACTIVITY; DISEASE-MODIFYING ANTIRHEUMATIC DRUGS; REMISSION; RHEUMATOID ARTHRITIS