Persistently active disease is common in patients with rheumatoid arthritis, particularly in women: a long-term inception cohort study.
OBJECTIVE
Despite improved treatment strategies for rheumatoid arthritis (RA), some patients do not respond satisfactorily. The aim of this study was to investigate the course and outcome of early RA diagnosed during the 1990s and followed for 8 years with a focus on those who did not respond well to treatment.


METHODS
This study included 640 patients (66% women) who were enrolled in the BARFOT (Better Anti-Rheumatic PharmacOTherapy) RA inception cohort between the years 1993 and 1999. The 28-joint count Disease Activity Score (DAS28) < 2.6 criteria were used to assess remission. Persistent disease (PD) was defined as absence of remission at all predefined follow-up visits at 1, 2, 5, and 8 years. Function was assessed by Health Assessment Questionnaire (HAQ) and Signals of Functional Impairment (SOFI) scores and radiological joint damage by the Sharp/van der Heijde score (SHS).


RESULTS
Of the 640 patients, 214 (37%) had PD (43% of the women and 25% of the men). Over the 8 years of follow-up, patients with PD had significantly worse mean values for patient's global health measured on a visual analogue scale (VAS patGH), VAS pain, HAQ, SOFI, and SHS compared with those in the non-PD group. Multivariate logistic regression analyses revealed that female gender, current smoking, disease activity at baseline, and absence of remission at 6 months independently predicted PD.


CONCLUSIONS
Of the patients who entered the early RA inception cohort, 37% suffered a PD course over 8 years. The consequences of PD with regard to general health, pain, function, and joint damage were considerable. Of note, PD was more common in women than in men.
a Department of Clinical Sciences , Section of Rheumatology, Lund University , Lund , Sweden.
B
B
Svensson
a Department of Clinical Sciences , Section of Rheumatology, Lund University , Lund , Sweden.|b Spenshult Research and Development Centre , Halmstad , Sweden.
Mle
M
Andersson
a Department of Clinical Sciences , Section of Rheumatology, Lund University , Lund , Sweden.|c Section of Rheumatology, Department of Medicine , Helsingborgs Lasarett , Helsingborg , Sweden.
K
K
Forslind
d Department of Rheumatology , Karolinska Institutet at Karolinska University Hospital , Huddinge , Sweden.
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S
Ajeganova
d Department of Rheumatology , Karolinska Institutet at Karolinska University Hospital , Huddinge , Sweden.
I
I
Hafström
D000328:Adult; D000368:Aged; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000453:epidemiology; D015331:Cohort Studies; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012737:Sex Factors; D013548:Sweden / Q000453:epidemiology; D017211:Treatment Failure
D018501:Antirheumatic Agents; D005938:Glucocorticoids