You are here

  • Home
  • Archive
  • Volume 2, Issue 2
  • Impact of intensive treatment and remission on health-related quality of life in early and established rheumatoid arthritis

Article Text

Article menu

Download PDFPDF

Rheumatoid arthritis
Original article
Impact of intensive treatment and remission on health-related quality of life in early and established rheumatoid arthritis
  1. I C Scott1,2,
  2. F Ibrahim3,
  3. C M Lewis2,
  4. D L Scott3 and
  5. V Strand4
  1. 1Academic Department of Rheumatology, Centre for Molecular and Cellular Biology of Inflammation, King's College London, London, UK
  2. 2Department of Medical and Molecular Genetics, King's College London, Guy's Hospital, London, UK
  3. 3Department of Rheumatology, Weston Education Centre, King's College Hospital, London, UK
  4. 4Division of Immunology/Rheumatology, Stanford University School of Medicine, Palo Alto, California, USA
  1. Correspondence to Dr I C Scott; ian.scott{at}kcl.ac.uk

Abstract

Objectives To establish if using intensive treatment to reduce synovitis and attain remission in active rheumatoid arthritis (RA) improves all aspects of health-related quality of life (HRQoL).

Methods A secondary analysis of two randomised clinical trials (CARDERA and TACIT) was undertaken. CARDERA randomised 467 patients with early active RA to different disease-modifying antirheumatic drug (DMARD) regimens, including high-dose tapering corticosteroids. TACIT randomised 205 established patients with active RA to combination DMARDs (cDMARDs) or tumour necrosis factor-α inhibitors (TNFis). Short-Form 36 (SF-36) measured HRQoL across eight domains, generating physical (PCS) and mental (MCS) component summary scores. Linear regression evaluated 6-month intensive treatment impacts. Mean SF-36 scores, stratified by end point disease activity category, were compared with age/gender-matched population scores.

Results In CARDERA, intensive corticosteroid treatment gave significantly greater improvements in PCS but not MCS scores relative to placebo. In TACIT, all eight SF-36 domains had improvements from baseline exceeding minimal clinically important differences with cDMARDs and TNFis. Significantly greater improvements with TNFi relative to cDMARDs were reported in PCS only (p=0.034), after adjusting for covariates. Remission provided the best SF-36 profiles, but scores in physical functioning, role physical and general health in both trials remained below normative values. Patient global assessment of disease activity had a greater association with HRQoL than other disease activity score (DAS28) components.

Conclusions Intensive corticosteroid treatment in early RA improves physical but not mental health, relative to placebo. In established RA, cDMARDs and TNFi provide similar improvements in HRQoL. As remission optimises but fails to normalise HRQoL, a focus on treatment strategies targeting HRQoL is required.

Trial registration numbers CARDERA was registered as ISRCTN 32484878. TACIT was registered as ISRCTN 37438295; pre-results.

  • Rheumatoid Arthritis
  • DMARDs (synthetic)
  • DMARDs (biologic)
  • Disease Activity

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

https://doi.org/10.1136/rmdopen-2016-000270

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    View Full Text