Association between rheumatoid arthritis disease activity, progression of functional limitation and long-term risk of orthopaedic surgery: Combined analysis of two prospective cohorts supports EULAR treat to target DAS thresholds

Elena Nikiphorou; Sam Norton; Adam Young; Lewis Carpenter; Josh Dixey; David Andrew Walsh; Patrick Kiely; Andrew Gough; Joe Devlin; Paul Emery; Lynn Waterhouse; David James; Helen Tate; Cathy Boys; Peter Williams; Dora White; Helen Dart; John Winfield; Annie Seymour; Richard Williams; Karina Blunn; Jackie McDowell; Peter Prouse; Sheryl Andrews; Deborah Wilson; Malgorzata Magliano; Ursula Perks; Amanda Coulson; Andrew Hassle; Michele Kirwan; Francesca Leone; Ciaran Dunne; Lindsey Hawley; Paul Creamer; Julie Taylor; Wendy Wilmott; Sally Knights; Rebecca Rowland-Axe; Sandra Green; Dawn Simmons; Joel David; Maureen Cox; Marwan Bukhari; Bronwen Evans; Michael Batley; Catherine Oram; ERAS and ERAN

doi:10.1136/annrheumdis-2015-208669

Association between rheumatoid arthritis disease activity, progression of functional limitation and long-term risk of orthopaedic surgery: Combined analysis of two prospective cohorts supports EULAR treat to target DAS thresholds

Elena Nikiphorou, Sam Norton, Adam Young, Lewis Carpenter, Josh Dixey, David Andrew Walsh, Patrick Kiely, Andrew Gough, Joe Devlin, Paul Emery, Lynn Waterhouse, David James, Helen Tate, Cathy Boys, Peter Williams, Dora White, Helen Dart, John Winfield, Annie Seymour, Richard WilliamsKarina Blunn, Jackie McDowell, Peter Prouse, Sheryl Andrews, Deborah Wilson, Malgorzata Magliano, Ursula Perks, Amanda Coulson, Andrew Hassle, Michele Kirwan, Francesca Leone, Ciaran Dunne, Lindsey Hawley, Paul Creamer, Julie Taylor, Wendy Wilmott, Sally Knights, Rebecca Rowland-Axe, Sandra Green, Dawn Simmons, Joel David, Maureen Cox, Marwan Bukhari, Bronwen Evans, Michael Batley, Catherine Oram, ERAS and ERAN

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Abstract

Objectives: To examine the association between disease activity in early rheumatoid arthritis (RA), functional limitation and long-term orthopaedic episodes. Methods: Health Assessment Questionnaire (HAQ) disability scores were collected from two longitudinal early RA inception cohorts in routine care; Early Rheumatoid Arthritis Study and Early Rheumatoid Arthritis Network from 1986 to 2012. The incidence of major and intermediate orthopaedic surgical episodes over 25 years was collected from national data sets. Disease activity was categorised by mean disease activity score (DAS28) annually between years 1 and 5; remission (RDAS≤2.6), low (LDAS>2.6-3.2), low-moderate (LMDAS≥3.2-4.19), high-moderate (HMDAS 4.2-5.1) and high (HDAS>5.1). Results: Data from 2045 patients were analysed. Patients in RDAS showed no HAQ progression over 5 years, whereas there was a significant relationship between rising DAS28 category and HAQ at 1 year, and the rate of HAQ progression between years 1 and 5. During 27 986 person-years follow-up, 392 intermediate and 591 major surgeries were observed. Compared with the RDAS category, there was a significantly increased cumulative incidence of intermediate surgery in HDAS (OR 2.59 CI 1.49 to 4.52) and HMDAS (OR 1.8 CI 1.05 to 3.11) categories, and for major surgery in HDAS (OR 2.48 CI 1.5 to 4.11), HMDAS (OR 2.16 CI 1.32 to 3.52) and LMDAS (OR 2.07 CI 1.28 to 3.33) categories. There was no significant difference in HAQ progression or orthopaedic episodes between RDAS and LDAS categories. Conclusions: There is an association between disease activity and both poor function and long-term orthopaedic episodes. This illustrates the far from benign consequences of persistent moderate disease activity, and supports European League Against Rheumatism treat to target recommendations to secure low disease activity or remission in all patients.

Original language	English
Pages (from-to)	2080-2086
Number of pages	7
Journal	Annals of the Rheumatic Diseases
Volume	75
Issue number	12
DOIs	https://doi.org/10.1136/annrheumdis-2015-208669
Publication status	Published - 10 Nov 2016

Keywords

Disease Activity
DMARDs (biologic)
DMARDs (synthetic)
Rheumatoid Arthritis
Treatment

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Nikiphorou, E., Norton, S., Young, A., Carpenter, L., Dixey, J., Walsh, D. A., Kiely, P., Gough, A., Devlin, J., Emery, P., Waterhouse, L., James, D., Tate, H., Boys, C., Williams, P., White, D., Dart, H., Winfield, J., Seymour, A., ... ERAS and ERAN (2016). Association between rheumatoid arthritis disease activity, progression of functional limitation and long-term risk of orthopaedic surgery: Combined analysis of two prospective cohorts supports EULAR treat to target DAS thresholds. Annals of the Rheumatic Diseases, 75(12), 2080-2086. https://doi.org/10.1136/annrheumdis-2015-208669

@article{222f2c621fcc4d908da3729bc26580b8,

title = "Association between rheumatoid arthritis disease activity, progression of functional limitation and long-term risk of orthopaedic surgery: Combined analysis of two prospective cohorts supports EULAR treat to target DAS thresholds",

abstract = "Objectives: To examine the association between disease activity in early rheumatoid arthritis (RA), functional limitation and long-term orthopaedic episodes. Methods: Health Assessment Questionnaire (HAQ) disability scores were collected from two longitudinal early RA inception cohorts in routine care; Early Rheumatoid Arthritis Study and Early Rheumatoid Arthritis Network from 1986 to 2012. The incidence of major and intermediate orthopaedic surgical episodes over 25 years was collected from national data sets. Disease activity was categorised by mean disease activity score (DAS28) annually between years 1 and 5; remission (RDAS≤2.6), low (LDAS>2.6-3.2), low-moderate (LMDAS≥3.2-4.19), high-moderate (HMDAS 4.2-5.1) and high (HDAS>5.1). Results: Data from 2045 patients were analysed. Patients in RDAS showed no HAQ progression over 5 years, whereas there was a significant relationship between rising DAS28 category and HAQ at 1 year, and the rate of HAQ progression between years 1 and 5. During 27 986 person-years follow-up, 392 intermediate and 591 major surgeries were observed. Compared with the RDAS category, there was a significantly increased cumulative incidence of intermediate surgery in HDAS (OR 2.59 CI 1.49 to 4.52) and HMDAS (OR 1.8 CI 1.05 to 3.11) categories, and for major surgery in HDAS (OR 2.48 CI 1.5 to 4.11), HMDAS (OR 2.16 CI 1.32 to 3.52) and LMDAS (OR 2.07 CI 1.28 to 3.33) categories. There was no significant difference in HAQ progression or orthopaedic episodes between RDAS and LDAS categories. Conclusions: There is an association between disease activity and both poor function and long-term orthopaedic episodes. This illustrates the far from benign consequences of persistent moderate disease activity, and supports European League Against Rheumatism treat to target recommendations to secure low disease activity or remission in all patients.",

keywords = "Disease Activity, DMARDs (biologic), DMARDs (synthetic), Rheumatoid Arthritis, Treatment",

author = "Elena Nikiphorou and Sam Norton and Adam Young and Lewis Carpenter and Josh Dixey and Walsh, {David Andrew} and Patrick Kiely and Andrew Gough and Joe Devlin and Paul Emery and Lynn Waterhouse and David James and Helen Tate and Cathy Boys and Peter Williams and Dora White and Helen Dart and John Winfield and Annie Seymour and Richard Williams and Karina Blunn and Jackie McDowell and Peter Prouse and Sheryl Andrews and Deborah Wilson and Malgorzata Magliano and Ursula Perks and Amanda Coulson and Andrew Hassle and Michele Kirwan and Francesca Leone and Ciaran Dunne and Lindsey Hawley and Paul Creamer and Julie Taylor and Wendy Wilmott and Sally Knights and Rebecca Rowland-Axe and Sandra Green and Dawn Simmons and Joel David and Maureen Cox and Marwan Bukhari and Bronwen Evans and Michael Batley and Catherine Oram and {ERAS and ERAN}",

year = "2016",

month = nov,

day = "10",

doi = "10.1136/annrheumdis-2015-208669",

language = "English",

volume = "75",

pages = "2080--2086",

journal = "Annals of the Rheumatic Diseases",

issn = "0003-4967",

publisher = "BMJ Publishing Group",

number = "12",

}

Nikiphorou, E, Norton, S, Young, A, Carpenter, L, Dixey, J, Walsh, DA, Kiely, P, Gough, A, Devlin, J, Emery, P, Waterhouse, L, James, D, Tate, H, Boys, C, Williams, P, White, D, Dart, H, Winfield, J, Seymour, A, Williams, R, Blunn, K, McDowell, J, Prouse, P, Andrews, S, Wilson, D, Magliano, M, Perks, U, Coulson, A, Hassle, A, Kirwan, M, Leone, F, Dunne, C, Hawley, L, Creamer, P, Taylor, J, Wilmott, W, Knights, S, Rowland-Axe, R, Green, S, Simmons, D, David, J, Cox, M, Bukhari, M, Evans, B, Batley, M, Oram, C & ERAS and ERAN 2016, 'Association between rheumatoid arthritis disease activity, progression of functional limitation and long-term risk of orthopaedic surgery: Combined analysis of two prospective cohorts supports EULAR treat to target DAS thresholds', Annals of the Rheumatic Diseases, vol. 75, no. 12, pp. 2080-2086. https://doi.org/10.1136/annrheumdis-2015-208669

Association between rheumatoid arthritis disease activity, progression of functional limitation and long-term risk of orthopaedic surgery: Combined analysis of two prospective cohorts supports EULAR treat to target DAS thresholds. / Nikiphorou, Elena; Norton, Sam; Young, Adam et al.
In: Annals of the Rheumatic Diseases, Vol. 75, No. 12, 10.11.2016, p. 2080-2086.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Association between rheumatoid arthritis disease activity, progression of functional limitation and long-term risk of orthopaedic surgery

T2 - Combined analysis of two prospective cohorts supports EULAR treat to target DAS thresholds

AU - Nikiphorou, Elena

AU - Norton, Sam

AU - Young, Adam

AU - Carpenter, Lewis

AU - Dixey, Josh

AU - Walsh, David Andrew

AU - Kiely, Patrick

AU - Gough, Andrew

AU - Devlin, Joe

AU - Emery, Paul

AU - Waterhouse, Lynn

AU - James, David

AU - Tate, Helen

AU - Boys, Cathy

AU - Williams, Peter

AU - White, Dora

AU - Dart, Helen

AU - Winfield, John

AU - Seymour, Annie

AU - Williams, Richard

AU - Blunn, Karina

AU - McDowell, Jackie

AU - Prouse, Peter

AU - Andrews, Sheryl

AU - Wilson, Deborah

AU - Magliano, Malgorzata

AU - Perks, Ursula

AU - Coulson, Amanda

AU - Hassle, Andrew

AU - Kirwan, Michele

AU - Leone, Francesca

AU - Dunne, Ciaran

AU - Hawley, Lindsey

AU - Creamer, Paul

AU - Taylor, Julie

AU - Wilmott, Wendy

AU - Knights, Sally

AU - Rowland-Axe, Rebecca

AU - Green, Sandra

AU - Simmons, Dawn

AU - David, Joel

AU - Cox, Maureen

AU - Bukhari, Marwan

AU - Evans, Bronwen

AU - Batley, Michael

AU - Oram, Catherine

AU - ERAS and ERAN

PY - 2016/11/10

Y1 - 2016/11/10

N2 - Objectives: To examine the association between disease activity in early rheumatoid arthritis (RA), functional limitation and long-term orthopaedic episodes. Methods: Health Assessment Questionnaire (HAQ) disability scores were collected from two longitudinal early RA inception cohorts in routine care; Early Rheumatoid Arthritis Study and Early Rheumatoid Arthritis Network from 1986 to 2012. The incidence of major and intermediate orthopaedic surgical episodes over 25 years was collected from national data sets. Disease activity was categorised by mean disease activity score (DAS28) annually between years 1 and 5; remission (RDAS≤2.6), low (LDAS>2.6-3.2), low-moderate (LMDAS≥3.2-4.19), high-moderate (HMDAS 4.2-5.1) and high (HDAS>5.1). Results: Data from 2045 patients were analysed. Patients in RDAS showed no HAQ progression over 5 years, whereas there was a significant relationship between rising DAS28 category and HAQ at 1 year, and the rate of HAQ progression between years 1 and 5. During 27 986 person-years follow-up, 392 intermediate and 591 major surgeries were observed. Compared with the RDAS category, there was a significantly increased cumulative incidence of intermediate surgery in HDAS (OR 2.59 CI 1.49 to 4.52) and HMDAS (OR 1.8 CI 1.05 to 3.11) categories, and for major surgery in HDAS (OR 2.48 CI 1.5 to 4.11), HMDAS (OR 2.16 CI 1.32 to 3.52) and LMDAS (OR 2.07 CI 1.28 to 3.33) categories. There was no significant difference in HAQ progression or orthopaedic episodes between RDAS and LDAS categories. Conclusions: There is an association between disease activity and both poor function and long-term orthopaedic episodes. This illustrates the far from benign consequences of persistent moderate disease activity, and supports European League Against Rheumatism treat to target recommendations to secure low disease activity or remission in all patients.

AB - Objectives: To examine the association between disease activity in early rheumatoid arthritis (RA), functional limitation and long-term orthopaedic episodes. Methods: Health Assessment Questionnaire (HAQ) disability scores were collected from two longitudinal early RA inception cohorts in routine care; Early Rheumatoid Arthritis Study and Early Rheumatoid Arthritis Network from 1986 to 2012. The incidence of major and intermediate orthopaedic surgical episodes over 25 years was collected from national data sets. Disease activity was categorised by mean disease activity score (DAS28) annually between years 1 and 5; remission (RDAS≤2.6), low (LDAS>2.6-3.2), low-moderate (LMDAS≥3.2-4.19), high-moderate (HMDAS 4.2-5.1) and high (HDAS>5.1). Results: Data from 2045 patients were analysed. Patients in RDAS showed no HAQ progression over 5 years, whereas there was a significant relationship between rising DAS28 category and HAQ at 1 year, and the rate of HAQ progression between years 1 and 5. During 27 986 person-years follow-up, 392 intermediate and 591 major surgeries were observed. Compared with the RDAS category, there was a significantly increased cumulative incidence of intermediate surgery in HDAS (OR 2.59 CI 1.49 to 4.52) and HMDAS (OR 1.8 CI 1.05 to 3.11) categories, and for major surgery in HDAS (OR 2.48 CI 1.5 to 4.11), HMDAS (OR 2.16 CI 1.32 to 3.52) and LMDAS (OR 2.07 CI 1.28 to 3.33) categories. There was no significant difference in HAQ progression or orthopaedic episodes between RDAS and LDAS categories. Conclusions: There is an association between disease activity and both poor function and long-term orthopaedic episodes. This illustrates the far from benign consequences of persistent moderate disease activity, and supports European League Against Rheumatism treat to target recommendations to secure low disease activity or remission in all patients.

KW - Disease Activity

KW - DMARDs (biologic)

KW - DMARDs (synthetic)

KW - Rheumatoid Arthritis

KW - Treatment

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U2 - 10.1136/annrheumdis-2015-208669

DO - 10.1136/annrheumdis-2015-208669

M3 - Article

C2 - 26979104

AN - SCOPUS:84962256188

SN - 0003-4967

VL - 75

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JO - Annals of the Rheumatic Diseases

JF - Annals of the Rheumatic Diseases

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Nikiphorou E, Norton S, Young A, Carpenter L, Dixey J, Walsh DA et al. Association between rheumatoid arthritis disease activity, progression of functional limitation and long-term risk of orthopaedic surgery: Combined analysis of two prospective cohorts supports EULAR treat to target DAS thresholds. Annals of the Rheumatic Diseases. 2016 Nov 10;75(12):2080-2086. doi: 10.1136/annrheumdis-2015-208669

Association between rheumatoid arthritis disease activity, progression of functional limitation and long-term risk of orthopaedic surgery: Combined analysis of two prospective cohorts supports EULAR treat to target DAS thresholds

Abstract

Keywords

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