Self-reported outcomes during treatment with tumour necrosis factor alpha inhibitors in patients with rheumatoid...

To study how patients with rheumatoid arthritis (RA) self-report their experience of disease-related symptoms (fatigue, morning stiffness, pain) and their ability to cope with everyday life (capacity) using a nurse-led structured follow-up during the first year after starting treatment with tumour necrosis factor alpha (TNF-alpha) inhibitors.

Thirty-nine patients, who were being treated for their RA in our outpatient rheumatology clinic and were beginning treatment with TNF-alpha inhibitors, agreed to evaluate and self-report their experience of fatigue, morning stiffness, pain, and capacity using the visual analogue scale (VAS) every third month during their first year of treatment. A quantitative method was used to study the changes in these four variables. In addition, at the same time, we studied the relationship between self-reported capacity and each of the three symptoms.

After 12 months' treatment with TNF-alpha inhibitors, the change (median interquartile range [IQR]) measured with VAS was -14 (-38, -7) mm for fatigue, -22 (-47, -4) mm for morning stiffness, -28 (-50, 0) mm for pain and -27 (-48, -6) mm for capacity. All changes were statistically significant (p < 0.001). Baseline and 12 months' capacity correlated significantly with fatigue, morning stiffness and pain (all p < 0.01). In addition, the median change in self-reported capacity correlated significantly with the median change in each of the three symptoms (p < 0.01).

During the first year of treatment with TNF-alpha inhibitors, patients reported decreased fatigue, morning stiffness and pain, while their capacity increased. The increased capacity rate closely followed the decrease in symptom rate.