Changing clinical patterns in rheumatoid arthritis management over two decades: sequential observational studies

Area of Science:

• Rheumatology
• Clinical Medicine
• Pharmacology

Background:

• Rheumatoid arthritis (RA) treatment has evolved, emphasizing combination DMARD therapy, biologics, and remission.
• Significant shifts in RA management strategies have occurred over the past two decades.

Purpose of the Study:

• To evaluate the impact of RA treatment changes on disease activity (DAS28) and disability (HAQ).
• To analyze trends in RA treatment, disease activity, and patient-reported disability over time.

Main Methods:

• Cross-sectional surveys conducted between 1996 and 2014 in London rheumatology departments.
• Analysis of drug therapy, DAS28, and HAQ scores in 1324 RA patients.
• Descriptive statistics and Spearman's correlations were used to summarize changes and assess relationships.

Main Results:

• RA treatment intensity increased, with higher use of DMARDs and biologics.
• Mean DAS28 scores decreased, and remission rates increased significantly.
• Health Assessment Questionnaire (HAQ) scores remained unchanged, and the correlation between DAS28 and HAQ weakened.

Conclusions:

• Increased treatment intensity in RA has led to reduced disease activity and more remissions.
• Despite improved synovitis control, patient-reported disability (HAQ) has not improved comparably.
• The divergence between disease activity and disability suggests that synovitis suppression alone may be insufficient for comprehensive RA management.