Earlier and more aggressive treatment of rheumatoid arthritis (RA) helps patients grip things, walk and dress themselves better — and live longer, a study suggests.
The daily lives of people with the condition have improved in the past 20 years, thanks to new therapies and new strategies for managing the disease, but early treatment generates the best results, the researchers said.
The study, “The 20-year outcome and association between early treatment and mortality and disability in an inception cohort of patients with rheumatoid arthritis: Results from the Norfolk Arthritis Register,” was published in journal of Arthritis and Rheumatology.
RA is a chronic disease characterized by joint inflammation. The second most common form of arthritis in the United Kingdom, it can lead to progressive joint destruction and premature mortality.
Two of the major advances in RA treatment the past two decades are synthetic disease modifying anti-rheumatic drugs, or sDMARDs, and biologic DMARDS, also known as bDMARDs. Methotrexate has become doctors’ first choice of sDMARD.
Researchers examined the outcomes of RA patients in the 20 years between 1990 and 2010, including physical function, disease activity and death. They also examined the relationship between the early start of sDMARD or steroid therapy, and patients’ physical function and mortality.
The study included 602 patients from the Norfolk Arthritis Register. Patients who began taking sDMARDs within six months of their symptoms developing were able to grip things, walk and dress better during the 20 years than patients who were treated later. The sDMARDs included methotrexate, sulfasalazine and steroids.
Patients who started on sDMARDs during their first six months of symptoms also were at lower risk of dying.
“This research shows that patients who received treatment early after symptom onset had similar levels of disability over the subsequent 20 years, compared to patients who were judged by clinicians not to require treatment, after accounting for the differences in disease severity between the groups,” James Gwinnutt of the University of Manchester, the study’s lead author, said in a news release.
“Though there is a broad range in terms of how people are affected by the disease, the number of patients whose lives have improved has increased, thanks in part to early treatment,” Gwinnutt added. “The good news is that early intervention has become more and more common in the NHS [National Health System] over these past 20 years. In the early 1990s early intervention would happen in about 30% of cases. Nowadays, that figure is probably more like 60-70%. “There’s no reason why this improvement could not extend further.”
“Rheumatoid arthritis is an incredibly painful condition that can be diagnosed at any age and can have an impact on a person’s everyday life,” said Natalie Carter, head of research liaison and evaluation at Arthritis Research UK. “This study confirms how important early diagnosis and the commencement of treatment is. It is also encouraging to hear about the progress that has been made over the last 20 years.”
“Now the scientific community must continue to build on this so that together we can continue to harness the power of exceptional science and make everyday life better for all people with arthritis,” Carter concluded.