Ten years of change in clinical disease status and treatment in rheumatoid arthritis: results based on standardized monitoring of patients in an ordinary outpatient clinic in southern Norway.
BACKGROUND
In the new millennium, clinical outcomes in patients with rheumatoid arthritis (RA) have improved. Despite a large number of register data, there is a lack of data reflecting the entire outpatient RA population, and in particular long-term data. The main aim of this study was to explore changes in clinical disease status and treatment in an RA outpatient clinic population monitored with recommended outcome measures over a 10-year period.


METHODS
Standard data collected included demographic data, erythrocyte sedimentation rate, C-reactive protein, clinical measures of disease activity (Disease Activity Score in 28 joint counts [DAS28], Clinical Disease Activity Index [CDAI], Simplified Disease Activity Index [SDAI] and global assessments) and patient-reported outcomes (measures of physical function, joint pain, fatigue, patient global assessment and morning stiffness). Treatment with disease-modifying antirheumatic drugs (DMARDs) was also recorded, as well as rheumatoid factor (RF) and anti-citrullinated protein antibody (ACPA) status.


RESULTS
In the RA population, the mean age was approximately 64 years and disease duration was 10-12 years. About 70 % were females; approximately 20 % were current smokers; and 65-70 % were positive for RF and ACPA. During follow-up, disease activity improved significantly. When we applied the DAS28, CDAI, SDAI and Boolean criteria for remission, the proportions of patients in remission increased from 21.3 %, 8.1 %, 5.8 % and 3.8 %, respectively, in 2004 to 55.5 %, 31.7 %, 31.8 % and 17.7 %, respectively, in 2013. The proportions of patients with DAS28, CDAI and SDAI low disease activity status were 16.0 %, 34.0 %, and 34.9 %, respectively, in 2004 and 17.8 %, 50.4 % and 50.8 %, respectively, in 2013. A significant improvement in patient-reported outcome was seen only for the full 10-years, but not for the last 4 years, of the study period. The proportion of patients taking synthetic (about 60 %) and biologic (approximately 30 %) DMARDs was stable over the last 4 years of the study period, with no significant change observed, whereas the proportion of patients being treated with prednisolone was reduced significantly from 61 % in 2010 to 54 % in 2013.


CONCLUSIONS
The encouraging data we present suggest that the vast majority of patients with RA monitored in outpatient clinics in the new millennium can expect to achieve a status of clinical remission or low disease activity.
Department of Rheumatology, Hospital of Southern Norway Trust, Servicebox 416, 4604, Kristiansand S, Norway. glenn.haugeberg@sshf.no.|Division of Rheumatology, Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway. glenn.haugeberg@sshf.no.
Glenn
G
Haugeberg
Department of Rheumatology, Hospital of Southern Norway Trust, Servicebox 416, 4604, Kristiansand S, Norway. inger.johanne.hansen@sshf.no.
Inger Johanne Widding
IJ
Hansen
Department of Rheumatology, Hospital of Southern Norway Trust, Servicebox 416, 4604, Kristiansand S, Norway. dag.magnar.soldal@sshf.no.
Dag Magnar
DM
Soldal
Department of Rheumatology, Jyväskylä Central Hospital, Jyväskylä, Finland. tuulikki.sokka-isler@ksshp.fi.
Tuulikki
T
Sokka
D000368:Aged; D000369:Aged, 80 and over; D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data*; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D009664:Norway; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data / Q000639:trends; D011239:Prednisolone / Q000627:therapeutic use*; D012074:Remission Induction; D012720:Severity of Illness Index; D013997:Time Factors
D018501:Antirheumatic Agents; D005938:Glucocorticoids; D011239:Prednisolone