Study Details Benefits of Early Treatment for Rheumatoid Arthritis

Early treatment for rheumatoid arthritis (RA) is associated with improved long-term outcomes and mortality risk compared with later treatment, according to a recent study.

For their study, researchers recruited 602 patients from the Norfolk Arthritis Register who met the 2010 ACR/EULAR RA criteria at baseline. Demographic and clinical variables were collected at baseline at years 1, 2, 3, 5, 7, 10, 15, and 20. The researchers defined early treatment as beginning treatment 6 months or less after symptom onset (n=160), and late treatment as beginning treatment more than 6 months after symptom onset (n=249).
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During follow-up, 205 (34.1%) patients died, and 135 declined further follow-up visits. Further, 8 became ineligible at year 5 and 47 were lost to follow-up.

In the Median disease activity was low over follow-up. Median disability, measured by the Health Assessment Questionnaire Disability Index (HAQ), rose after 1 year but remained low/moderate. Reduced mortality risk was observed in individuals in the early and late treatment groups, compared with the no treatment group. The early treatment group had a comparable HAQ score to the no treatment group over the course of follow-up, while the late treatment group had increased disability compared with the no treatment group.

“In this analysis we found that, after adjusting for confounding by indication…patients who were treated early had similar levels of disability over follow-up to those who did not receive treatment, whilst patients treated later had significantly higher levels of disability over 20 years. This supports the importance of the ‘window of opportunity’ construct for treatment, showing that early treatment leads to improved outcomes even into the second decade following symptom onset.”

—Michael Potts

Reference:

Gwinnutt JM, Symmons DPM, MacGregor AJ, et al. 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 [published online