Remission required before RA treatment benefits working life
MedWire News: Patients with early rheumatoid arthritis (RA) must have a major response to treatment before it has a significant impact on their work outcomes, study findings demonstrate.
Patients who did not meet clinical criteria for remission on the 28-joint Disease Activity Score (DAS-28) or show 70% improvement on the American College of Rheumatology criteria for improvement (ACR70) were significantly more likely than responders to stop working or miss working days.
Aslam Anis (St Paul's Hospital, Vancouver, British Columbia, Canada) and co-workers examined the impact of treatment response on work outcomes in 205 early RA patients participating in a trial of methotrexate alone or with etanercept.
The patients were aged an average of 45 years old, 69% were female, and they had had RA for an average of 8.7 months. At the start of the trial, the patients had high levels of disease activity, pain and fatigue, with moderate-to-severe disability, and poor quality of life.
All patients worked full- or part-time at baseline and were followed-up over the first year of treatment.
Analysis of the 12-, 24-, 36- and 52-week checkpoints showed that 8.5%, 5.4%, 3.3% and 1.4% of patients had stopped working, respectively. The proportion of patients who missed work also fell over the period, from 18.5% at week 12 to 14.8% at week 52.
These reductions reflect the increasing number of responders over the study period, the researchers comment.
In particular, the number of ACR70 patients rose from 27.0% at week 12 to 46.6% at week 52, and was accompanied by an increase in the proportion of patients achieving a good European League Against Rheumatism criteria response, from 39.5% to 65.4%.
However, after adjusting for age, gender, ethnicity, treatment drug, and other baseline characteristics, the researchers found that ACR70 responders were a significant 72% less likely to stop working and 55% less likely to miss work than patients who did not achieve even a 20% response on the ACR improvement criteria.
Similarly, patients who achieved DAS-28 remission were a significant 54% less likely to stop work than those who did not.
Of note, patients who experienced only a moderate improvement on these clinical scores were not less likely to stop work or miss days than those who had no or little improvement.
"This suggests that achieving clinical remission or major improvement might be necessary to significantly impact work outcomes," Anis et al comment in the journal Rheumatology.
MedWire (www.medwire-news.md) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2011
By Lynda Williams