Impact of Intensive Treatment and Remission on Health-related Quality of Life in Early and Established Rheumatoid Arthritis

Overview

Journal RMD Open

Publisher BMJ Publishing Group

Specialty Rheumatology

Date 2016 Sep 22

PMID 27651924

Citations 13

Authors

I C Scott

F Ibrahim

C M Lewis

D L Scott

V Strand

Affiliations

Soon will be listed here.

Abstract

Objectives: To establish if using intensive treatment to reduce synovitis and attain remission in active rheumatoid arthritis (RA) improves all aspects of health-related quality of life (HRQoL).

Methods: A secondary analysis of two randomised clinical trials (CARDERA and TACIT) was undertaken. CARDERA randomised 467 patients with early active RA to different disease-modifying antirheumatic drug (DMARD) regimens, including high-dose tapering corticosteroids. TACIT randomised 205 established patients with active RA to combination DMARDs (cDMARDs) or tumour necrosis factor-α inhibitors (TNFis). Short-Form 36 (SF-36) measured HRQoL across eight domains, generating physical (PCS) and mental (MCS) component summary scores. Linear regression evaluated 6-month intensive treatment impacts. Mean SF-36 scores, stratified by end point disease activity category, were compared with age/gender-matched population scores.

Results: In CARDERA, intensive corticosteroid treatment gave significantly greater improvements in PCS but not MCS scores relative to placebo. In TACIT, all eight SF-36 domains had improvements from baseline exceeding minimal clinically important differences with cDMARDs and TNFis. Significantly greater improvements with TNFi relative to cDMARDs were reported in PCS only (p=0.034), after adjusting for covariates. Remission provided the best SF-36 profiles, but scores in physical functioning, role physical and general health in both trials remained below normative values. Patient global assessment of disease activity had a greater association with HRQoL than other disease activity score (DAS28) components.

Conclusions: Intensive corticosteroid treatment in early RA improves physical but not mental health, relative to placebo. In established RA, cDMARDs and TNFi provide similar improvements in HRQoL. As remission optimises but fails to normalise HRQoL, a focus on treatment strategies targeting HRQoL is required.

Trial Registration Numbers: CARDERA was registered as ISRCTN 32484878. TACIT was registered as ISRCTN 37438295; pre-results.

Citing Articles

Pain management in people with inflammatory arthritis: British Society for Rheumatology guideline scope.

Scott I, Babatunde O, Barker C, Beesley R, Beesley R, Birkinshaw H Rheumatol Adv Pract. 2024; 8(4):rkae128.

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Comprehensive relationship between disease activity indices, mTSS, and mHAQ and physical function evaluation and QOL in females with rheumatoid arthritis.

Nagafusa T, Mizushima T, Suzuki M, Yamauchi K Sci Rep. 2023; 13(1):21905.

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Prediction of flare following glucocorticoids withdrawal in rheumatoid arthritis patients with continuation of csDMARDs: a real-life study.

Xie W, Huang H, Zhang Z Intern Emerg Med. 2023; 18(6):1759-1767.

PMID: 37418144 DOI: 10.1007/s11739-023-03362-0.

Defining the relationship between pain intensity and disease activity in patients with rheumatoid arthritis: a secondary analysis of six studies.

Ibrahim F, Ma M, Scott D, Scott I Arthritis Res Ther. 2022; 24(1):218.

PMID: 36088424 PMC: 9463789. DOI: 10.1186/s13075-022-02903-w.

It is not just about sex: viewpoints of men with inflammatory arthritis on the overall impact of the disease on their sexual health.

Perez-Garcia L, Roder E, Pastoor H, Bolt J, van Exel J, Dolhain R RMD Open. 2021; 7(3).

PMID: 34580174 PMC: 8477326. DOI: 10.1136/rmdopen-2021-001821.

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