There is a link between a person\u2019s disease activity and the worsening of their functional limitations and need for long-term orthopaedic surgery.<\/p>\n
INTRODUCTION
\nRheumatoid arthritis is a chronic inflammatory disease that affects a person\u2019s joints and sometimes their internal organs, causing pain and disability. It is more common in older people, and affects both men and women.
\nSince there is currently no cure for rheumatoid arthritis, treatment aims to help people get into remission or at least to have low disease activity. This is called the treat to target strategy (sometimes shortened to T2T). Being able to get into remission or low disease activity early in your disease is more likely if you receive an effective
\ntreatment promptly. Some countries and healthcare systems are able to provide this quick treatment. However, some systems restrict the use of the most effective treatments (the biologic disease-modifying anti-rheumatic drugs, also called bDMARDs) or biologics) to patients with high disease activity levels only because they can be very expensive.
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WHAT DID THE AUTHORS HOPE TO FIND?
\nThe authors wanted to understand how a person\u2019s functional ability (for example, being able to undertake normal activities of daily life) and joint destruction (as measured by the need for joint surgery), relate to their different disease activity levels between the first and fifth year after starting treatment for their rheumatoid arthritis.<\/p>\n
WHO WAS STUDIED?
\nThe study involved over 2000 people with rheumatoid arthritis in two very large studies in the UK. Everyone taking part had been diagnosed with the disease within 3 years of the onset of their symptoms. The studies took place between 1986 and 2012 from clinics across England, Wales and Ireland. People received treatment and medicines according to the normal care that would be given in their clinic.<\/p>\n
HOW WAS THE STUDY CONDUCTED? There is a link between a person\u2019s disease activity and the worsening of their functional limitations and need for long-term orthopaedic surgery. INTRODUCTION Rheumatoid arthritis is a chronic inflammatory disease that affects a person\u2019s joints and sometimes their internal organs, causing pain and disability. It is more common in older people, and affects both men […]<\/p>\n
\nThe study used data from existing databases. There was no study intervention or medicine being tested. People with rheumatoid arthritis tend to be seen at their clinics regularly \u2013 for as many as 25 years from the time they are first diagnosed, so it is possible to explore symptoms and features that people had early in their disease, and compare these with how they did later on.
\nThere were two databases developed as part of the study. These were linked to three other national databases, which improved the quality of the data being looked at. When they were looking at the data, the authors put surgical procedures into one of two groups, depending on the joint type and procedure. \u2018Major\u2019 procedures
\nwere those involving a large joint (such as the hips, knees) or joint replacements. \u2018Intermediate\u2019 procedures mainly involved people\u2019s wrists, hands or feet. People\u2019s functional ability was measured using a questionnaire that asked about typical daily activities, such as being able to walk and get dressed without help. This helped the
\nauthors to see how people\u2019s abilities changed over time.
\nWHAT WERE THE MAIN FINDINGS?
\nThe study found that people with rheumatoid arthritis in remission had no change in their functional ability over five years. People with worse or higher disease activity and poor functional ability early on also had quicker functional decline between years 1 and 5. There was no difference in functional ability in people with either low
\ndisease activity and those in remission. People with moderate or high disease activity states had a higher risk of needing both intermediate and major surgery.
\nARE THESE FINDINGS NEW?
\nThe consequences of moderate disease activity on functional ability and the need for orthopaedic surgery have not been examined in this much detail before. The way the study linked into the three national datasets makes it unique, and means the quality and accuracy of the results are very good.
\nARE THERE ANY LIMITATIONS?
\nIt is not possible to draw conclusions about cause and effect from this type of study. That means we cannot say whether different types of treatment that people used had an impact on their functional abilities or the types of joint surgery that they needed.
\nWHAT DO THE AUTHORS PLAN ON DOING WITH THIS INFORMATION?
\nThe authors plan to look in greater detail at people who are classed as being in low disease activity or remission. They will look at specific differences in outcomes for these people, including their functional ability or need for joint surgery.
\nWHAT DOES THIS MEAN FOR ME?
\nIf you have been diagnosed with rheumatoid arthritis, it is important to try to keep your disease in remission, or at least in a low disease activity state. Being in higher disease activity may worsen your function and increase your risk of joint damage, eventually meaning you need to have surgery on your joints. Having early and intensive treatment and treating to a target of remission or at least low disease activity can increase the likelihood of better outcomes.
\nIf you would like to know more about treating to target and ways to achieve remission, you should speak to your doctor.
\nDisclaimer:<\/strong> This is a summary of a scientific article written by a medical professional (\u201cthe Original Article\u201d).The Summary is written to assist non medically trained readers to understand general points of the Original Article. It is supplied \u201cas is\u201d without any warranty. You should note that the Original Article (and Summary) may not be fully relevant nor accurate as medical science is constantly changing and errors can occur. It is therefore very important that readers not rely on the content in the Summary and consult their medical professionals for all aspects of their health care and only rely on the Summary if directed to do so by their medical professional. Please view our full Website Terms and Conditions.
\nDate prepared: September 2016
\nSummary based on research article published on: 15 March 2016
\nFrom: Nikiphorou, E. et al. Association between rheumatoid arthritis disease activity, progression of functional limitation and long-term risk of orthopaedic surgery: combined analysis of two prospective cohorts supportsEULAR treat to target DAS thresholds. Ann Rheum Dis 2016;0:1\u20137. doi: 10.1136\/annrheumdis-2015-208669.
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