title: Treatment with the first TNF inhibitor in rheumatoid arthritis patients in the Hellenic Registry of Biologic Therapies improves quality of life especially in young patients with better baseline functional status.
abstract: OBJECTIVE
  To assess in daily practice in patients with rheumatoid arthritis (RA) the effect of treatment with first tumour necrosis factor-α inhibitor (TNFi) in quality of life (Qol), disease activity and depict possible baseline predictors for gains in Qol.
  
  
  METHODS
  Patients followed prospectively by the Hellenic Registry of Biologic Therapies were analysed. Demographics were recorded at baseline, while RA-related characteristics at baseline and every 6 months. Paired t-tests were used to detect divergences between patient-reported (Health Assessment Questionnaire (HAQ), EuroQol (EQ-5D)) and clinical tools (Disease Activity Score-28 joints (DAS28)). Clinical versus self-reported outcomes were examined via cross-tabulation analysis. Multiple regression analysis was performed for identifying baseline predictors of improvements in QALYs.
  
  
  RESULTS
  We analysed 255 patients (age (mean±SD) 57.1±13.0, disease duration 9.2±9.1 years, prior non-biologic disease-modifying anti-rheumatic drugs 2.3±1.2). Baseline EQ-5D, HAQ and DAS28 were 0.36 (0.28), 1.01 (0.72) and 5.9 (1.3), respectively, and were all significantly improved after 12 months (0.77 (0.35), 0.50 (0.66), 3.9 (1.5), respectively, p<0.05 for all). 90% of patients who improved from high to a lower DAS28 status (low-remission or moderate) had clinically important improvement in Qol (phi-coefficient=0.531,p<0.05). Independent predictors of gains in Qol were lower baseline HAQ, VAS global and younger age (adjusted R2=0.27).
  
  
  CONCLUSIONS
  In daily practice TNFi improve both disease activity and Qol for the first 12 months of therapy. 90% of patients who improved from high to a lower DAS28 status had clinically important improvement in Qol. Younger patients starting with lower HAQ and VAS global are more likely to benefit.
authors.affiliation: Department of Health Economics, National School of Public Health, Athens, Greece.
authors.forename: Nadia
authors.initials: N
authors.lastname: Boubouchairopoulou
authors.affiliation: Rheumatology, Clinical Immunology and Allergy, Medical School, University of Crete, Greece.
authors.forename: Irini
authors.initials: I
authors.lastname: Flouri
authors.affiliation: Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina, Ioannina, Greece.
authors.forename: Alexandros A
authors.initials: AA
authors.lastname: Drosos
authors.affiliation: Rheumatology Department, Sismanoglio Hospital, Athens, Greece.
authors.forename: Kyriaki
authors.initials: K
authors.lastname: Boki
authors.affiliation: First Department of Internal Medicine, Rheumatology Section, AHEPA Hospital of the Aristotle University Medical School, Thessaloniki, Greece.
authors.forename: Loukas
authors.initials: L
authors.lastname: Settas
authors.affiliation: Department of Rheumatology, 424 General Army Hospital, Thessaloniki, Greece.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Zisopoulos
authors.affiliation: Department of Nutrition and Diebetics, Harokopio University, Athens, Greece.
authors.forename: Fotini N
authors.initials: FN
authors.lastname: Skopouli
authors.affiliation: Rheumatology Clinic, General Hospital of Kavala, Greece.
authors.forename: Ioannis
authors.initials: I
authors.lastname: Papadopoulos
authors.affiliation: Department of Rheumatology, Veterans Administration Hospital, Athens, Greece.
authors.forename: Alexios
authors.initials: A
authors.lastname: Iliopoulos
authors.affiliation: Department of Health Economics, National School of Public Health, Athens, Greece.
authors.forename: John
authors.initials: J
authors.lastname: Kyriopoulos
authors.affiliation: Joint Academic Rheumatology Program, Faculty of Medicine, National and Kapodestrian University of Athens, Athens, Greece.
authors.forename: Dimitrios T
authors.initials: DT
authors.lastname: Boumpas
authors.affiliation: Department of Health Economics, National School of Public Health, Athens, Greece.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Athanasakis
authors.affiliation: Rheumatology, Clinical Immunology and Allergy, Medical School, University of Crete, Greece. sidiropp@uoc.gr.
authors.forename: Prodromos
authors.initials: P
authors.lastname: Sidiropoulos
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000175:diagnosis / Q000188:drug therapy*; D001688:Biological Products / Q000627:therapeutic use*; D005260:Female; D006115:Greece; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D012042:Registries; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D018501:Antirheumatic Agents; D001688:Biological Products; D014409:Tumor Necrosis Factor-alpha