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Has the severity of rheumatoid arthritis at presentation diminished over time?
J Rheumatol. 2014 Aug; 41(8):1590-9.JR

Abstract

OBJECTIVE

To examine the pattern of disease severity in patients with rheumatoid arthritis (RA) at presentation to the Norfolk Arthritis Register (NOAR) over 20 years.

METHODS

NOAR is a primary-care-based cohort of patients with recent-onset inflammatory polyarthritis. At baseline, subjects are assessed and examined by a research nurse. The Health Assessment Questionnaire (HAQ) is administered and the DAS28 (28-joint Disease Activity Score) is calculated. Information is collected on disease-modifying antirheumatic drug exposure. In this study, patients (symptom duration of < 2 years at baseline) were grouped into 4 cohorts (Cohort 1: 1990-1994; Cohort 2: 1995-1999; Cohort 3: 2000-2004; Cohort 4: 2005-2008). The American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) 2010 criteria for RA were applied retrospectively at baseline. Regression analyses were used to examine whether calendar year of presentation to NOAR was associated with baseline HAQ and DAS28 scores. Potential confounders included age at symptom onset, sex, rheumatoid factor, and anticyclic citrullinated peptide antibody positivity.

RESULTS

A total of 1724 patients met the ACR/EULAR 2010 RA criteria at baseline. Unadjusted mean DAS28 scores decreased over time. Calendar year of presentation to NOAR was significantly associated with lower DAS28 scores over time [Y = 4.51 + (-0.56 × year) + (0.44 × year(2))]. Although unadjusted median HAQ scores increased over time, calendar year of presentation to NOAR was not significantly associated with HAQ scores [Y = (1.1) + (0.023 × year) + (0.05 × year(2))]. Similar results were observed in each subpopulation of patients.

CONCLUSION

While baseline disease activity has lessened slightly over time, there has been no improvement in baseline levels of functional disability.

Authors+Show Affiliations

From the Arthritis Research UK Centre for Epidemiology, Manchester Academic Health Science Centre, and The School of Nursing, Midwifery, and Social Work, University of Manchester, Manchester; Department of Rheumatology, Norfolk and Norwich University Hospital, Norwich; Norfolk Arthritis Register (NOAR), School of Medicine, Health Policy, and Practice, University of East Anglia, Norwich; UK National Institute for Health Research (NIHR) Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals National Health Service (NHS) Foundation Trust and University of Manchester Partnership, Manchester, UK.J.G. Diffin, PhD, Research Associate, Arthritis Research UK Centre for Epidemiology, Manchester Academic Health Science Centre, and The School of Nursing, Midwifery, and Social Work, University of Manchester; M. Lunt, PhD, Reader in Medical Statistics, Arthritis Research UK Centre for Epidemiology, Manchester Academic Health Science Centre, University of Manchester; T. Marshall, MD, Consultant Rheumatologist, Department of Rheumatology, Norfolk and Norwich University Hospital; J.R. Chipping, NOAR Deputy Clinical Manager, School of Medicine, Health Policy, and Practice, University of East Anglia; D.P.M. Symmons, MD, FRCP, FFPH, Arthritis Research UK Centre for Epidemiology, Manchester Academic Health Science Centre, University of Manchester, and NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust and University of Manchester Partnership; S.M.M. Verstappen, PhD, Senior Research Fellow, Arthritis Research UK Centre for Epidemiology, Manchester Academic Health Science Centre, University of Manchester.From the Arthritis Research UK Centre for Epidemiology, Manchester Academic Health Science Centre, and The School of Nursing, Midwifery, and Social Work, University of Manchester, Manchester; Department of Rheumatology, Norfolk and Norwich University Hospital, Norwich; Norfolk Arthritis Register (NOAR), School of Medicine, Health Policy, and Practice, University of East Anglia, Norwich; UK National Institute for Health Research (NIHR) Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals National Health Service (NHS) Foundation Trust and University of Manchester Partnership, Manchester, UK.J.G. Diffin, PhD, Research Associate, Arthritis Research UK Centre for Epidemiology, Manchester Academic Health Science Centre, and The School of Nursing, Midwifery, and Social Work, University of Manchester; M. Lunt, PhD, Reader in Medical Statistics, Arthritis Research UK Centre for Epidemiology, Manchester Academic Health Science Centre, University of Manchester; T. Marshall, MD, Consultant Rheumatologist, Department of Rheumatology, Norfolk and Norwich University Hospital; J.R. Chipping, NOAR Deputy Clinical Manager, School of Medicine, Health Policy, and Practice, University of East Anglia; D.P.M. Symmons, MD, FRCP, FFPH, Arthritis Research UK Centre for Epidemiology, Manchester Academic Health Science Centre, University of Manchester, and NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust and University of Manchester Partnership; S.M.M. Verstappen, PhD, Senior Research Fellow, Arthritis Research UK Centre for Epidemiology, Manchester Academic Health Science Centre, University of Manchester.From the Arthritis Research UK Centre for Epidemiology, Manchester Academic Health Science Centre, and The School of Nursing, Midwifery, and Social Work, University of Manchester, Manchester; Department of Rheumatology, Norfolk and Norwich University Hospital, Norwich; Norfolk Arthritis Register (NOAR), School of Medicine, Health Policy, and Practice, University of East Anglia, Norwich; UK National Institute for Health Research (NIHR) Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals National Health Service (NHS) Foundation Trust and University of Manchester Partnership, Manchester, UK.J.G. Diffin, PhD, Research Associate, Arthritis Research UK Centre for Epidemiology, Manchester Academic Health Science Centre, and The School of Nursing, Midwifery, and Social Work, University of Manchester; M. Lunt, PhD, Reader in Medical Statistics, Arthritis Research UK Centre for Epidemiology, Manchester Academic Health Science Centre, University of Manchester; T. Marshall, MD, Consultant Rheumatologist, Department of Rheumatology, Norfolk and Norwich University Hospital; J.R. Chipping, NOAR Deputy Clinical Manager, School of Medicine, Health Policy, and Practice, University of East Anglia; D.P.M. Symmons, MD, FRCP, FFPH, Arthritis Research UK Centre for Epidemiology, Manchester Academic Health Science Centre, University of Manchester, and NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust and University of Manchester Partnership; S.M.M. Verstappen, PhD, Senior Research Fellow, Arthritis Research UK Centre for Epidemiology, Manchester Academic Health Science Centre, University of Manchester.From the Arthritis Research UK Centre for Epidemiology, Manchester Academic Health Science Centre, and The School of Nursing, Midwifery, and Social Work, University of Manchester, Manchester; Department of Rheumatology, Norfolk and Norwich University Hospital, Norwich; Norfolk Arthritis Register (NOAR), School of Medicine, Health Policy, and Practice, University of East Anglia, Norwich; UK National Institute for Health Research (NIHR) Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals National Health Service (NHS) Foundation Trust and University of Manchester Partnership, Manchester, UK.J.G. Diffin, PhD, Research Associate, Arthritis Research UK Centre for Epidemiology, Manchester Academic Health Science Centre, and The School of Nursing, Midwifery, and Social Work, University of Manchester; M. Lunt, PhD, Reader in Medical Statistics, Arthritis Research UK Centre for Epidemiology, Manchester Academic Health Science Centre, University of Manchester; T. Marshall, MD, Consultant Rheumatologist, Department of Rheumatology, Norfolk and Norwich University Hospital; J.R. Chipping, NOAR Deputy Clinical Manager, School of Medicine, Health Policy, and Practice, University of East Anglia; D.P.M. Symmons, MD, FRCP, FFPH, Arthritis Research UK Centre for Epidemiology, Manchester Academic Health Science Centre, University of Manchester, and NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust and University of Manchester Partnership; S.M.M. Verstappen, PhD, Senior Research Fellow, Arthritis Research UK Centre for Epidemiology, Manchester Academic Health Science Centre, University of Manchester.From the Arthritis Research UK Centre for Epidemiology, Manchester Academic Health Science Centre, and The School of Nursing, Midwifery, and Social Work, University of Manchester, Manchester; Department of Rheumatology, Norfolk and Norwich University Hospital, Norwich; Norfolk Arthritis Register (NOAR), School of Medicine, Health Policy, and Practice, University of East Anglia, Norwich; UK National Institute for Health Research (NIHR) Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals National Health Service (NHS) Foundation Trust and University of Manchester Partnership, Manchester, UK.J.G. Diffin, PhD, Research Associate, Arthritis Research UK Centre for Epidemiology, Manchester Academic Health Science Centre, and The School of Nursing, Midwifery, and Social Work, University of Manchester; M. Lunt, PhD, Reader in Medical Statistics, Arthritis Research UK Centre for Epidemiology, Manchester Academic Health Science Centre, University of Manchester; T. Marshall, MD, Consultant Rheumatologist, Department of Rheumatology, Norfolk and Norwich University Hospital; J.R. Chipping, NOAR Deputy Clinical Manager, School of Medicine, Health Policy, and Practice, University of East Anglia; D.P.M. Symmons, MD, FRCP, FFPH, Arthritis Research UK Centre for Epidemiology, Manchester Academic Health Science Centre, University of Manchester, and NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust and University of Manchester Partnership; S.M.M. Verstappen, PhD, Senior Research Fellow, Arthritis Research UK Centre for Epidemiology, Manchester Academic Health Science Centre, University of Manchester.From the Arthritis Research UK Centre for Epidemiology, Manchester Academic Health Science Centre, and The School of Nursing, Midwifery, and Social Work, University of Manchester, Manchester; Department of Rheumatology, Norfolk and Norwich University Hospital, Norwich; Norfolk Arthritis Register (NOAR), School of Medicine, Health Policy, and Practice, University of East Anglia, Norwich; UK National Institute for Health Research (NIHR) Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals National Health Service (NHS) Foundation Trust and University of Manchester Partnership, Manchester, UK.J.G. Diffin, PhD, Research Associate, Arthritis Research UK Centre for Epidemiology, Manchester Academic Health Science Centre, and The School of Nursing, Midwifery, and Social Work, University of Manchester; M. Lunt, PhD, Reader in Medical Statistics, Arthritis Research UK Centre for Epidemiology, Manchester Academic Health Science Centre, University of Manchester; T. Marshall, MD, Consultant Rheumatologist, Department of Rheumatology, Norfolk and Norwich University Hospital; J.R. Chipping, NOAR Deputy Clinical Manager, School of Medicine, Health Policy, and Practice, University of East Anglia; D.P.M. Symmons, MD, FRCP, FFPH, Arthritis Research UK Centre for Epidemiology, Manchester Academic Health Science Centre, University of Manchester, and NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust and University of Manchester Partnership; S.M.M. Verstappen, PhD, Senior Research Fellow, Arthritis Research UK Centre for Epidemiology, Manchester Academic Health Science Centre, University of Manchester. Suzanne.Verstappen@manchester.ac.uk.

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

24986850

Citation

Diffin, Janet G., et al. "Has the Severity of Rheumatoid Arthritis at Presentation Diminished Over Time?" The Journal of Rheumatology, vol. 41, no. 8, 2014, pp. 1590-9.
Diffin JG, Lunt M, Marshall T, et al. Has the severity of rheumatoid arthritis at presentation diminished over time? J Rheumatol. 2014;41(8):1590-9.
Diffin, J. G., Lunt, M., Marshall, T., Chipping, J. R., Symmons, D. P., & Verstappen, S. M. (2014). Has the severity of rheumatoid arthritis at presentation diminished over time? The Journal of Rheumatology, 41(8), 1590-9. https://doi.org/10.3899/jrheum.131136
Diffin JG, et al. Has the Severity of Rheumatoid Arthritis at Presentation Diminished Over Time. J Rheumatol. 2014;41(8):1590-9. PubMed PMID: 24986850.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Has the severity of rheumatoid arthritis at presentation diminished over time? AU - Diffin,Janet G, AU - Lunt,Mark, AU - Marshall,Tarnya, AU - Chipping,Jacqueline R, AU - Symmons,Deborah P M, AU - Verstappen,Suzanne M M, Y1 - 2014/07/01/ PY - 2014/7/3/entrez PY - 2014/7/6/pubmed PY - 2015/4/10/medline KW - CHANGES OVER TIME KW - DISEASE ACTIVITY KW - DISEASE SEVERITY KW - FUNCTIONAL DISABILITY KW - INCEPTION COHORT KW - RHEUMATOID ARTHRITIS SP - 1590 EP - 9 JF - The Journal of rheumatology JO - J Rheumatol VL - 41 IS - 8 N2 - OBJECTIVE: To examine the pattern of disease severity in patients with rheumatoid arthritis (RA) at presentation to the Norfolk Arthritis Register (NOAR) over 20 years. METHODS: NOAR is a primary-care-based cohort of patients with recent-onset inflammatory polyarthritis. At baseline, subjects are assessed and examined by a research nurse. The Health Assessment Questionnaire (HAQ) is administered and the DAS28 (28-joint Disease Activity Score) is calculated. Information is collected on disease-modifying antirheumatic drug exposure. In this study, patients (symptom duration of < 2 years at baseline) were grouped into 4 cohorts (Cohort 1: 1990-1994; Cohort 2: 1995-1999; Cohort 3: 2000-2004; Cohort 4: 2005-2008). The American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) 2010 criteria for RA were applied retrospectively at baseline. Regression analyses were used to examine whether calendar year of presentation to NOAR was associated with baseline HAQ and DAS28 scores. Potential confounders included age at symptom onset, sex, rheumatoid factor, and anticyclic citrullinated peptide antibody positivity. RESULTS: A total of 1724 patients met the ACR/EULAR 2010 RA criteria at baseline. Unadjusted mean DAS28 scores decreased over time. Calendar year of presentation to NOAR was significantly associated with lower DAS28 scores over time [Y = 4.51 + (-0.56 × year) + (0.44 × year(2))]. Although unadjusted median HAQ scores increased over time, calendar year of presentation to NOAR was not significantly associated with HAQ scores [Y = (1.1) + (0.023 × year) + (0.05 × year(2))]. Similar results were observed in each subpopulation of patients. CONCLUSION: While baseline disease activity has lessened slightly over time, there has been no improvement in baseline levels of functional disability. SN - 0315-162X UR - https://www.unboundmedicine.com/medline/citation/24986850/Has_the_severity_of_rheumatoid_arthritis_at_presentation_diminished_over_time DB - PRIME DP - Unbound Medicine ER -