Improvements in the therapeutic management of early rheumatoid arthritis (RA) in recent years have led to improvements in clinical, but not patient-reported outcomes, according to study results published in Rheumatology.

In this longitudinal study, investigators examined the progression of disease activity, functional disability, and measures of health-related quality of life using both clinical and patient-reported outcomes in early rheumatoid arthritis, comparing trends from different time periods.

A total of 2701 patients with a confirmed diagnosis of rheumatoid arthritis were included: 1465 patients recruited from the Early Rheumatoid Arthritis Study which took place between 1986 and 2001, and 1236 patients recruited from the Early Rheumatoid Arthritis Network conducted between 2002 and 2011. The 5–year trajectory of disease activity evaluated with inflammatory markers was estimated for different time periods: in patients diagnosed in 1990, 2002, and 2010. Clinical markers used included the 28-joint count Disease Activity Score (DAS28) and the erythrocyte sedimentation rate (ESR), and patient-reported outcomes, included the Health Assessment Questionnaire (HAQ)–Disability Index, a visual analog scale for pain and overall health, and the 36-Item Short-Form to assess quality of life.

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The 28-joint count DAS and ESR scores were found to improve in patients diagnosed in 2010 vs 1990 or 2002 during a 5-year period. Patients diagnosed in 2010 had improved DAS28 scores compared with patients diagnosed in 1990 (difference, 1.12 unit; 95% CI, 0.90-1.35; P <.001) and with patients diagnosed in 2002 (difference, 0.45 unit; 95% CI, 0.36-0.54; P <.001). The probability of reaching an ESR ≤10 was estimated to be achieved in 51%, 20%, and 37% of patients diagnosed in 2010, 1990, and 2002, respectively. By 5 years, 63% of patients diagnosed in 2010 were estimated to reach low disease activity vs 31% of patients diagnosed in 1990 and 50% of patients diagnosed in 2002.HAQ scores ≤1.0 at 60 months were reported by 60%, 61%, and 54% of patients diagnosed in 2010, 2002, and 1990, respectively. Visual analog scale scores were improved in patients diagnosed in 1990 vs 2002 or 2010.

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Study limitations include the use of prospective cohorts, the absence of global assessment scores (a component of DAS28) in participants from the Early Rheumatoid Arthritis Study, and the use of a visual analog scale to report overall health.

“The role of improved therapeutic managements has been instrumental in lowering inflammation and reducing the inflammatory aspects of the disease over the last 30 years, the so-called objective markers. However, there is a clear need to examine the subjective aspects of the disease, which is driving the discordance between objective measures of inflammation, and the patient-reported measures,” concluded the study authors.


Carpenter L, Nikiphorou E, Kiely PDW, Walsh DA, Young A, Norton S. Secular changes in the progression of clinical markers and patient-reported outcomes in early rheumatoid arthritis [published online January 3, 2020]. Rheumatology. doi: 10.1093/rheumatology/kez635