TY - JOUR
T1 - Evidence That Both the Disease Course & Structural Outcomes in RA Have Become Less Severe over Time. A 25-Year Longitudinal Data Analysis Based on Two Consecutive UK Inception Cohorts
AU - Nikiphorou, E.
AU - Norton, S.
AU - Carpenter, L.
AU - Dixey, J.
AU - Kiely, P.
AU - Walsh, D.
AU - Young, A.
N1 - © 2014 Author(s). Published by Elsevier B.V. All rights are reserved.
PY - 2025/1/3
Y1 - 2025/1/3
N2 - Background
Evidence suggests that disease expression and course in RA has become less severe. It is unclear whether this is due to changes in disease phenotype/expression or reflects earlier more effective therapy.
Objectives
To test the hypothesis that the course of RA & structural outcomes have become less severe in recent years.
Methods
A total of 2701 DMARD-naïve patients were recruited over 25yrs in two UK RA inception cohorts with a single continuous mode of data collection:Early RA Study (9 centres, 1986-1998) & Early RA Network (23 centres, 2002-2012). Standardized clin/lab & x-ray measures were performed at baseline prior to DMARDs & yearly, along with comorbidities & in-patient hospital episodes including orthopaedic surgery (OS). Clinical databases were supplemented & validated with UK sources: National Joint Registry, Hospital Episode Statistics & National Death Register. Therapies included DMARDs, steroids & biologics based on standard UK practices and published guidelines.
Results
Of 2701 early RA patients, 67% were female, mean age 56yrs (±14) & 62% rheumatoid factor positive (RF+ve), median follow-up 9 yrs (IQR 13). Over 25yrs of study, a shift towards more intensive therapy was seen: from monotherapy (1st choice DMARD: sulphasalazine in the 1st decade, methotrexate in the 2nd) to dual combinations, triple therapy & biologics. Graphics will dispay these trends. Over the recruitment periods, there was no significant change in gender (p=0.648), RF+ve (p=0.775), or erosions at baseline (p=0.695). Age at disease onset increased by 0.22 years/year (p=0.001), indicating a later disease-onset over time despite times from symptom onset to specialist diagnosis changing little (median 6 months). In models controlling for centre, age & gender, baseline clin/lab variables that significantly decreased with every year included:DAS (by 0.03 unit,p
AB - Background
Evidence suggests that disease expression and course in RA has become less severe. It is unclear whether this is due to changes in disease phenotype/expression or reflects earlier more effective therapy.
Objectives
To test the hypothesis that the course of RA & structural outcomes have become less severe in recent years.
Methods
A total of 2701 DMARD-naïve patients were recruited over 25yrs in two UK RA inception cohorts with a single continuous mode of data collection:Early RA Study (9 centres, 1986-1998) & Early RA Network (23 centres, 2002-2012). Standardized clin/lab & x-ray measures were performed at baseline prior to DMARDs & yearly, along with comorbidities & in-patient hospital episodes including orthopaedic surgery (OS). Clinical databases were supplemented & validated with UK sources: National Joint Registry, Hospital Episode Statistics & National Death Register. Therapies included DMARDs, steroids & biologics based on standard UK practices and published guidelines.
Results
Of 2701 early RA patients, 67% were female, mean age 56yrs (±14) & 62% rheumatoid factor positive (RF+ve), median follow-up 9 yrs (IQR 13). Over 25yrs of study, a shift towards more intensive therapy was seen: from monotherapy (1st choice DMARD: sulphasalazine in the 1st decade, methotrexate in the 2nd) to dual combinations, triple therapy & biologics. Graphics will dispay these trends. Over the recruitment periods, there was no significant change in gender (p=0.648), RF+ve (p=0.775), or erosions at baseline (p=0.695). Age at disease onset increased by 0.22 years/year (p=0.001), indicating a later disease-onset over time despite times from symptom onset to specialist diagnosis changing little (median 6 months). In models controlling for centre, age & gender, baseline clin/lab variables that significantly decreased with every year included:DAS (by 0.03 unit,p
U2 - 10.1136/annrheumdis-2014-eular.4972
DO - 10.1136/annrheumdis-2014-eular.4972
M3 - Article
SN - 0003-4967
VL - 73
SP - 125
JO - Annals of the Rheumatic Diseases
JF - Annals of the Rheumatic Diseases
IS - Supplement 2
M1 - OP0167
ER -