People with rheumatoid arthritis (RA) – particularly women – have less pain, less fatigue, and better physical function today than they did in the mid-1990s, a large study from Norway suggests.
INTRODUCTION
Over the last 20 years, treatment options for RA have expanded with the introduction of TNF inhibitors and other new types of DMARDs (disease-modifying anti-rheumatic drugs). Examples include adalimumab, etanercept, infliximab, abatacept and rituximab. Strategies for managing RA have also improved, with studies finding that earlier and more intensive treatment can improve people’s symptoms and slow down the damage to their
joints.
Although these improvements would suggest that people today are able to cope better with their RA than in previous decades, not many long-term studies have explored this.
WHAT DID THE RESEARCHERS HOPE TO FIND?
Researchers in Norway wanted to take a close look at how people with RA were faring today compared with in the mid-1990s. They were particularly interested in improvements among women, as women generally get RA earlier and have worse symptoms compared with men.
WHO WAS STUDIED?
The study included men and women with RA who were aged 20 to 79 and lived in Oslo. By including a wide range of people, the researchers aimed to fully represent people with RA who lived in this area of Norway.
HOW WAS THE STUDY CONDUCTED?
The researchers sent questionnaires to people with RA in 1994, 1996, 2001, 2004, and 2009. These included questions about the people’s level of pain and fatigue, and how much their RA affected their daily activities (such as dressing, walking, and gripping things with their hands). The questionnaires also asked about their age
and lifestyle, how their health was overall, and what medicines they were taking for RA.
The researchers compared how people responded to the questionnaires throughout the study, to see whether people with RA were doing better at the end of the study than at the start. They also looked separately at men and women.
WHAT DOES THE NEW STUDY SAY?
Between 800 and 1,000 people responded to the questionnaires each year they were sent out. The researchers found considerable improvements in how people rated their RA throughout the study. In particular, people had less pain and fatigue in 2009 than in 1994. They also could do more daily activities, and rated their RA as
being less active. They also rated their overall health more highly.
Women had greater improvements than men, which narrowed the differences between the sexes quite a bit.
However, women continued to have worse symptoms overall.
The researchers also found that many more people started using DMARDs over the course of the study. This reflects the more intensive approach to treatment that has been adopted in recent years.
HOW RELIABLE ARE THE FINDINGS?
These findings should be fairly reliable, as the study has several important strengths. For example, it was quite large, and it used thorough questionnaires. The researchers also accounted for things that can affect a person’s RA symptoms and health, such as their age, their sex, whether they smoked, how long they’d had RA, and
whether they had other illnesses. This allowed them to more reliably compare people’s responses throughout the study.
However, we can’t be certain that some of the findings – such as improvements in people’s overall health – was because of improvements in their RA. Other changes in people’s lives and health also could have played a role.
It’s also worth noting that the researchers looked only at people with RA in Oslo. So we can’t be certain that the findings would be the same for other groups of people in other countries.
WHAT DOES THIS MEAN FOR ME?
If you have RA this study provides positive news, finding that people with the disease are faring better today than in the mid-1990s. This suggests that improved medicines and treatment strategies have made a real difference for many people.
These findings are also important for payers of health care, as they suggest that investing in newer treatments for RA does indeed improve people’s health and wellbeing. But, of course, what’s most important is how you feel as an individual. If your symptoms are getting worse or interfering with your activities, talk to your doctor. There may be other treatments that can help.
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Date summary prepared: January 2015
Summary based on research article published on: 15 October 2013
From: Austad, C, et al. Health status has improved more in women than in men with rheumatoid arthritis from 1994 to 2009: results from the Oslo rheumatoid arthritis register. Ann Rheum Dis 2015;74:148-155 doi:10.1136/annrheumdis-2013-204014
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