title: Impact of intensive treatment and remission on health-related quality of life in early and established rheumatoid arthritis.
abstract: OBJECTIVE
  To establish if using intensive treatment to reduce synovitis and attain remission in active rheumatoid arthritis (RA) improves all aspects of health-related quality of life (HRQoL).
  
  
  METHODS
  A secondary analysis of two randomised clinical trials (CARDERA and TACIT) was undertaken. CARDERA randomised 467 patients with early active RA to different disease-modifying antirheumatic drug (DMARD) regimens, including high-dose tapering corticosteroids. TACIT randomised 205 established patients with active RA to combination DMARDs (cDMARDs) or tumour necrosis factor-α inhibitors (TNFis). Short-Form 36 (SF-36) measured HRQoL across eight domains, generating physical (PCS) and mental (MCS) component summary scores. Linear regression evaluated 6-month intensive treatment impacts. Mean SF-36 scores, stratified by end point disease activity category, were compared with age/gender-matched population scores.
  
  
  RESULTS
  In CARDERA, intensive corticosteroid treatment gave significantly greater improvements in PCS but not MCS scores relative to placebo. In TACIT, all eight SF-36 domains had improvements from baseline exceeding minimal clinically important differences with cDMARDs and TNFis. Significantly greater improvements with TNFi relative to cDMARDs were reported in PCS only (p=0.034), after adjusting for covariates. Remission provided the best SF-36 profiles, but scores in physical functioning, role physical and general health in both trials remained below normative values. Patient global assessment of disease activity had a greater association with HRQoL than other disease activity score (DAS28) components.
  
  
  CONCLUSIONS
  Intensive corticosteroid treatment in early RA improves physical but not mental health, relative to placebo. In established RA, cDMARDs and TNFi provide similar improvements in HRQoL. As remission optimises but fails to normalise HRQoL, a focus on treatment strategies targeting HRQoL is required.
  
  
  BACKGROUND
  CARDERA was registered as ISRCTN 32484878. TACIT was registered as ISRCTN 37438295; pre-results.
authors.affiliation: Academic Department of Rheumatology, Centre for Molecular and Cellular Biology of Inflammation, King's College London, London, UK; Department of Medical and Molecular Genetics, King's College London, Guy's Hospital, London, UK.
authors.forename: I C
authors.initials: IC
authors.lastname: Scott
authors.affiliation: Department of Rheumatology , Weston Education Centre, King's College Hospital , London , UK.
authors.forename: F
authors.initials: F
authors.lastname: Ibrahim
authors.affiliation: Department of Medical and Molecular Genetics , King's College London, Guy's Hospital , London , UK.
authors.forename: C M
authors.initials: CM
authors.lastname: Lewis
authors.affiliation: Department of Rheumatology , Weston Education Centre, King's College Hospital , London , UK.
authors.forename: D L
authors.initials: DL
authors.lastname: Scott
authors.affiliation: Division of Immunology/Rheumatology , Stanford University School of Medicine , Palo Alto, California , USA.
authors.forename: V
authors.initials: V
authors.lastname: Strand
keywords: DMARDs (biologic); DMARDs (synthetic); Disease Activity; Rheumatoid Arthritis