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Effect of Fatigue, Older Age, Higher Body Mass Index, and Female Sex on Disability in Early Rheumatoid Arthritis in the Treatment‐to‐Target Era
Author(s) -
Twigg Sarah,
Hensor Elizabeth M. A.,
Freeston Jane,
Tan Ai Lyn,
Emery Paul,
Tennant Alan,
Morgan Ann W.
Publication year - 2018
Publication title -
arthritis care and research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.032
H-Index - 163
eISSN - 2151-4658
pISSN - 2151-464X
DOI - 10.1002/acr.23281
Subject(s) - medicine , rheumatoid arthritis , rheumatism , confidence interval , rheumatology , odds ratio , cohort , adverse effect , logistic regression , body mass index , physical therapy , arthritis
Objective To compare disease activity and disability over 2 years in early rheumatoid arthritis ( RA ) before and after implementation of treat‐to‐target therapy and identify predictors of adverse outcome. Methods The Yorkshire Early Arthritis Register ( YEAR ) recruited 725 patients with early RA between 2002 and 2009, treated with a step‐up approach. The Inflammatory Arthritis Continuum study ( IACON ) recruited cases between 2010 and 2014 and treated to target. A total of 384 IACON cases met 2010 American College of Rheumatology/European League Against Rheumatism criteria. Latent growth curves of change in Disease Activity Score in 28 joints ( DAS 28) and the Health Assessment Questionnaire ( HAQ ) were compared between YEAR and IACON . Latent class growth analysis identified trajectories of change. Baseline predictors of trajectories were identified using logistic regression. Results The mean DAS 28 over 2 years was lower in IACON than in YEAR . Latent trajectories of HAQ change in YEAR were high stable (21% of cohort), moderate reducing (35%), and low reducing (44%). Only moderate reducing (66%) and low reducing (34%) were seen in IACON . In both cohorts, female sex and fatigue predicted adverse HAQ trajectories (high stable and moderate reducing). Odds ratios ( OR s) for moderate reducing compared to low reducing for women were 2.58 (95% confidence interval [95% CI ] 1.69, 4.49) in YEAR and 5.81 (95% CI 2.44, 14.29) in IACON . OR s per centimeter fatigue visual analog score were 1.13 (95% CI 1.07, 1.20) in YEAR and 1.16 (95% CI 1.12, 1.20) in IACON . Conclusion Treat‐to‐target therapy gave more favorable trajectories of change in DAS 28 and HAQ , but adverse HAQ trajectory was more likely in women with greater fatigue, suggesting such patients would benefit from interventions to improve function as well as reduce inflammation.