medwireNews: Patients with early rheumatoid arthritis (RA) who report higher HAQ-measured disability after taking DMARDs for a year are at greater risk for all-cause mortality than those who report lower disability scores, indicate findings from the Canadian Early Arthritis Cohort.
The study investigators speculate in Arthritis & Rheumatology that “poorer disease control (high DAS28) within the first treatment year for RA may lead to increased disability (high HAQ scores) which in turn may contribute to higher mortality.”
They add: “This may indicate that RA patients who do not have a deep response in the first year to treatment have higher subsequent mortality.”
Janet Pope (University of Western Ontario, London, Canada) and colleagues analyzed data pertaining to 1724 individuals with RA aged an average of 55 years (72% female). The patients had symptoms of fixed swelling for less than a year and initiated treatment with at least one DMARD between 2007 and 2017.
Over a 10-year follow-up, the 62 (2.4%) patients who died had significantly higher mean HAQ scores at baseline than those who remained alive during follow-up, at 1.2 versus 1.0 points, and also after a year of treatment, at 0.9 versus 0.5 points.
Similarly, patients who died had higher average DAS28 scores than those who did not, with respective scores of 5.4 and 4.9 points at baseline and 3.6 versus 2.8 points after a year of treatment.
Multivariable analysis, adjusted for factors including education, smoking, seropositivity, symptom duration, and oral glucocorticoid use, demonstrated a significant association between the HAQ score at 1 year and all-cause mortality, at an odds ratio of 1.87.
By contrast, although the HAQ score at baseline was significantly associated with mortality in univariate analysis, the statistical significance was lost after adjusting for confounding factors.
Pope et al also found that patients who died were significantly more likely to be older, male, smokers, have lower education and less employment, and more comorbidities than patients who remained alive during follow-up.
They say “[t]his is helpful in a clinical setting as it can guide physician-patient discussions in terms of risk factors associated with prognosis, prescribing glucocorticoids, counselling on smoking cessation, monitoring treatment responses and focusing on patient education.”
The team concludes: “Future research can separate the interplay between disease activity which is also associated with mortality both at baseline and after treatment (at one year) and other factors such as damage and patient perceptions of function and comorbidities.”
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